Appendix E — Form for Completion Certificate

Reference number: ________________________
Permit number: __________________________
Address of the site:
Plot number: ________________________ Holding number: ___________________
Dag/Khatian number: _________________ Mouza/Block/Sector: _______________
Street name: ________________________    Municipal ward number: ____________
Documents enclosed along with this form:
                         ______________________
                         ______________________
Type of work (Check one)
Develop           Erect           Demolish            Alter

Name of the owner:     ______________________________________
Contact address:       _____________________________________
                       _____________________________________
                       _____________________________________
Post code:             ____________________
Telephone No:          ____________________

I hereby certify that the work having the above mentioned detailed particulars has been
supervised by me and completed in accordance with the plan and design approved by the
permit number cited and the provisions of the Bangladesh National Building Code.
________________________________________________
Signature of the engineer, architect, planner or supervisor
________________________________________________
Name of the engineer, architect, planner or supervisor
________________________________________________
Address
_________________________________________________               __________________
Qualification                                                   Signature of the owner
________________________                                        __________________
Date                                                            Date
This Part to be completed by the Building Official.
The work identified by the reference number and permit number at the top of the form is
hereby accepted as complete in accordance with the approved plan and design.
________________________
Signature of the Officer
________________________                                       ___________________
Name of the Officer                                            Official stamp
________________________                                       ___________________
Designation                                                    Date