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Date of Bi h
Fath e rs N q
Gen d er
Nation
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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