RE019(00) Page1of1
Application for Supplementary ID Card
Name of the student :________________________________________________
Student ID No. :________________________________________________
Department/Program :________________________________________________
Contact Number :________________________________________________
Declaration by the student;
I have forgotten to bring/show ULAB student ID card for access and related activities. I may please be allowed a supplementary ID card and the fine of Tk.100.00 (Taka One Hundred) only be charged against my student ID at ULAB.
___________________________
Signature of the student
Date:____________________For Office use only
The student whose name and ID number appears above consented to adjust the fine/payment of Tk.100.00 (Taka One Hundred) only for supplementary ID card be charged against his/her account with ULAB.
S/he was been issued with ID card #_____________________.
