Registration Point Premium Testing Venue
IELTS Student Enrollment Form                        Date:
Title: Dr.             Mr. .         Miss.             Mrs.        Ms.
Name:     Syed Nowrose Ninad
Father’s/Spouse Name:          Syed Nazrul Islam
Mother’s Name:      Most. Kamrunnahar Kona
Date of Birth: D         D       M       M         Y    E     A   R      Gender:   Male •          Female
                   0    9        0      5          2    0     0   6
Single •         Married
Academic Qualification:         HSC
Academic Institute:      Dhaka Residential Model College
Present Address:       62/63 Probal Housing, Ring Road, Mohammadpur
Guardian’s Cell: 015 6004 4246
Student’s Cell:    01625554839
E-mail:   snninad@gmail.com
IELTS:     AC •           GT
UKVI:      AC •           GT
You heard about: Facebook •                   Leaflet          Word of Mouth        Newspaper
IELTS Exam Date: 08/05/2025
Desired Band Score 8.0
Which country/territory are you applying to/intending to go to? Malaysia
Are you a client of IALC?            YES               NO
Admission cannot be cancelled & fees are non-refundable. Request on this ground will not be entertained.
I hereby agree to abide by the rules and regulations of IALC as in forse from time to time.
          Signature of the Student                                Signature of the Admission Officer