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Mother's name
Father's name
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female:
others:
Date of Birth
Marital Status :
single:
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widowed:
widower:
Blood Group
Educational Qualification
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Door no
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Declaration: I hereby declare that all the information I have given in this application is true, correct, and complete and is not false or misleading. I declare that the signature on this form is my signature, and has not been signed on my behalf by another person, including my agent or sponsor. I understand giving false or misleading information is a serious offence under state and / or central law of India.
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