PCB

Application Panel for the Pharmacy Certificate Registration Course(NB: Fill-out the form in English) .

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Enrollment date is now over. You are not eligible for the application.

Training center*

Session*

PERSONAL INFORMATION

Full Name( According to SSC or Equivalent Certificate)*

Father's Name ( According to SSC or Equivalent Certificate)*

Mother's Name ( According to SSC or Equivalent Certificate)*

Applicant's Mobile *

Applicant's Email*

Passing Year *

NID

Birth Certificate

National ID: *

Gender *

Pharmacy Name * (Must be fill-out in English)

Pharmacy Address* (Must be fill-out in English)

Nationality *

Religion *

Upload profile picture (Use the picture that you want to see in your certificate and must be size 300px * 300px)

Image resize link

PRESENT ADDRESS

Division *

District *

Thana / Upazila*

Union/ Ward*

Road No/ Name/ Village Name (Must be fill-out in English)

House (Optional) (Must be fill-out in English)

Location (Optional) (Must be fill-out in English)

Post Office Name (Must be fill-out in English)

Post Code

PERMANENT ADDRESS

Is the permanent address same as present address? *

Yes No

DOCUMENTS

Max allowed file size 1MB and file must be pdf. Resize your file Click here

Document Type *

Document File*

Roll no: *

Reg. no: *

Document Type *

Document File*

Document Type *

Document File*

Document Type *

Document File*

tc_ Portal username *

Password *

Center Name:	Total Seat:
Booked:	Availble: