1. Yeasmin Akhter is applying for registration as an Income Tax Practitioner and has submitted her application form with personal and educational details. 2. She completed her SSC in 2004, HSC in 2006, and graduation from the National University in 2010, and obtained a Masters from the State University of Bangladesh in 2014. 3. Yeasmin Akhter is applying under section 174 and rule-37 of the Income Tax ordinance,1984 and declares the information provided is correct to the best of her knowledge.

1. ITPRF-01
Application Form for Income Tax Practitioner (ITP) Registration-2017
Use Uppercase Letters (Unless Instructed Otherwise). Write one letter in each box. Keep an empty box
between two words
1. Name of the Applicant:
Y E A S M I N - A K H T E R
2. Av‡e`bKvixi bvg (evsjvq):
3. Father's/Husband’s Name (As per National ID):
M D . A B D U L - H A M I D
4. Mother's Name:
M O N I R A - B E G U M
5. Present Address (Mailing Address):
House 100/C, (2nd floor) Poolpar, Royer Bazar Mohammadpur
District: Post code
6. Permanent Address:
Vill+Post: Satarbari, Thana: Goforgaon, District: Mymensingh
District: Post code:
7. Educational Qualifications (Fill in appropriate columns only):
Sl. Name of Exam Board/University Year of
Passing
Roll No GPA/Class/
Division
1. SSC or Equivalent Dhaka 2004 410862 3.44
2. HSC or Equivalent Dhaka 2006 570946 4.30
Attach 2 copies of
Passport size
photo of the
Applicant here
Dhaka 1207
Mymensingh 2233

2. 3. Graduation National
University
2010 0730942 3.31
4. Masters State University
Of Bangladesh
2014 3.54
5. Law
6. Degree/Diploma in Taxation
7. Degree/Diploma in Banking
with Higher Auditing
8. Others (If any)
8. Date of Birth: 9. Nationality:
1 9 1 2 1 9 8 8 B A N G L A D E S H I
10. National ID Card No. 11. Mobile No:
1 9 8 8 2 6 9 5 0 4 7 9 9 1 5 1 3 0 1 9 6 9 6 1 3 4 9 1
12. E-mail Address:
yeasminshishir@yahoo.com
13. Treasury Challan Information:
Challan No: Date:
Treasury Bank: Branch:
I am applying for registration as Income Tax Practitioner (ITP) under section 174 and rule-37 of the
Income Tax ordinance,1984.
I solemnly declare that to the best of my knowledge and belief the information given hereinabove is
correct and complete.
Signature of the Applicant
Date:
Full Name : Yeasmin Akhter
Please do not write anything below this line
(For official use only)
A. Sl. No:
Roll No:

3. Written: Vive-Voce: Total:
Admit card for the written and viva-voce examinations applicable for the eligible candidates will be forwarded to the
mailing address in column-5 of this application form.