User RegistrationDate of Connection(Required)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Mobile Number(Required)Applicant's Passport Size Photo(Required)Max. file size: 256 MB.Subscriber Name (Individual/Organization)(Required)Authorized Person's Name(Required)National ID No. (For Bangladeshi)(Required)Date of Birth(Required)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Gender(Required) Male Female OthersBlood Group(Required)Occupation(Required)Present Address(Required) Section/Village Area/Block Road/Lane Thana/Upazila District Post Office Code Premanent Address(Required) Section/Village Area/Block Road/Lane Thana/Upazila District Post Office Code Package / Bandwidth Speed(Required)Connection Type(Required) Cat-5 Fiber OpticBandwidth Type(Required) Shared DedicatedMonthly Rate (Taka)(Required)Email Address(Required) Billing Address(Required) Present Address Permanent AddressI do hereby declare that the information and data given above are correct. In case of any false information, I shall be liable to appropriate legal action and I shall abide all terms and conditions of internet use as per BTRC and laws of the country. I also agree thet I shall pay the monthly bill prepaid of the running month & not discoutinue our service within three (3) months of activation.Organization SignatureDate(Required)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Applicant's Signature(Required)