BANGLADESH WATER DEVELOPMENT BOARD

9jf}bIOlC,,:rq ~ Office of the Director

~~9j~'tfi Directorate of Staff Development
~~(~o~~ Rahman Chamber (9th Floor),
~~-~" 1f~Riij ~/~, ~-~ooo 12-13 Motijheel C,A, Dhaka-1000.
~ ~(tlrlr8(tlr, ~tt(to~"tt ~ I Phone: 9588458, 9550937 (Fax).
~-~ [email protected] www.bwdb.gov.bd E-mail: [email protected]

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 FORM NO. 4
Vide, Sub-rule (1) of rule 10.

Medical certificate of health of a candidate for entry into service of Water

Development Board.

I hereby certify that I have examined Mr./Mrs./Miss .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. … ..

.. … .. .. … .. .. .. .. … .. .. .. .. ……................... …..,a candidate for employment to the post of ..

.. … .. … … .. … … …........................ … .. … .. … and cannot discover that Mr. /Mrs. / Miss

............ …………………… ………… ……… … …............... has any disease, constitutional

weakness or bodily infirmity except .… …………………………………... . I do not consider

this is a disqualification fo employment to the post of ............................. ………… ……

…… …………. . His/Her age is, according to ………...… ........... ……….. own statement

…………...…..... Years, and by appearance about ……...……. Years.

Place ………. Signature of medical officer

Date ……………… Designation

 FORM NO. 12
(Vide Sub-rule (1) of rule 137)

PROPERTY AND ASSETS HELD AT THE TIME OF ENTRY INTO THE SERVICE ON

Name of the employee …………………………………………………………………

Designation …………………………………………………………………………….

Description Date of Acquired Location of Value of How Remarks

Acquisition and held in immovable assets or acquired (if
the name(s) property property at purchased,
of the time of state source
acquisition of fund)
Immovable
property

Insurance
Policies

Stock and
Share
Certificates

Jewellery
etc.

Motor Vehicle

Televission

Refrigerator
etc.

From Price paid

whom and source
acquired. of funds.

Note:- Assets or property mean land and house acquired, built or under construction, stocks, share,
share certificates, Insurance policies, Television sets, Refrigerator, Motor Vehicles and
include any assets of property which are under mortgage of which are otherwise
encumbered.

I hereby declare that the above descriptions are to the best of my knowledge and belief, a
complete and accurate statement of assets held by me or on my behalf or by my wife, children and
dependents. This has been signed by me on…………………… .

Signature ………………………………

Designation ……………………………