Health Parliament Application - Wellbeing Foundation

Important Information

Each parliamentary constituency will have only ONE final selected representative.
If multiple applicants apply from the same constituency, selection will be made through exam/interview.
Application fee (BDT 500) is non-refundable.
Incomplete applications will not be considered.

Section 1Eligibility Confirmation

Please confirm your eligibility before proceeding.

I am a citizen of Bangladesh. I am associated with the selected constituency. I understand the application fee is non-refundable. I agree to the interview/exam-based selection process.

Section 2Personal Information

Full Name (As per NID) *

Father's Name *

Mother's Name *

Date of Birth *

National ID Number (NID) *

Upload NID Copy (Front & Back) *

Upload Recent Official Photo (Passport Size) *

Section 3Contact Information

Mobile Number *

Email Address *

Facebook Profile Link

Permanent Address *

Present Address (If Different)

Section 4Educational & Professional Information

Highest Educational Qualification *

Upload Last Academic Certificate *

Are you currently a student? *

Upload Student Document

Current Profession/Occupation *

Section 5Social Engagement

Are you involved in any voluntary/social organization? *

Organization Name & Role

Section 6Constituency Information

Constituency Name *

Constituency Number *

Are you a resident of this constituency? *

Section 7Motivation

Why do you want to become a representative of Health Parliament Bangladesh? * 0 / 100 words

Mention the three major health challenges in your constituency. * 0 / 300 words

Section 8Payment Information

BDT 500

Send BDT 500 via bKash and enter the transaction details below.

Application Fee is Non-Refundable

bKash Transaction ID *

Payment Date *

bKash Number (Used for Payment) *

Section 9Declaration

Please read and agree to the following declarations to submit your application.

I declare that all information provided is true and correct. I understand the application fee is non-refundable. I agree to comply with the rules and final decision of Health Parliament Bangladesh.

Constituency Representative Application

Important Information