so a r Ct

Date of Bi h

Fath e rs N q

** ’"*2/1998

Gen d er

Nation

a e

{ (y

female

• ajesh war g$J

£t i

Re ligion

Marital Stat S

L g tl age I o 1

Perm anen t Address

Declaration

lildian Hindu

un married

English & H:cdi

Village- bakoriya Po: bal oriya

Ps- mamma Latehar (dt), Jharkhand. Pincode-822 126

I hereby declare that all the above information provided by me is true.

Date: Place:

ARTl KUMARI