fen / erp aftrares ot ars/ Name of Father / Legal Guardien

SHIVA DALIPARTI

‘aren a Ts / Name of Mother

DURGA DALIPARTI

‘uf a1 ae a ara / Name of Spouse

‘wen / Address

*-**/*,********* **EDHI,MARAMPALLI

TADEPALLIGUDEM MANDAL,WEST GODAVARI ey

PIN:534146,ANDHRA PRADESH,INDIA

RP arevatd wor a, afte Sai Gre) GF @ fester Gea airs / Old Passport No. with Date and Place of Issue

weiga 4./ File No. waaole

VS2069692263316