PEMSONAL DETAILS
Nhe
Vather’s Name
Mathers Name
Date of Hirth
aby;
hy ling
Many, a van Hembra
Soni th [fe abrir
TY in qibrann
Crender
o . Mite
Category 44
Marital Status . Un
I
Religion tint d
‘ {
Nationality Ind u
Language Known
x Ke Hindi Sa
resent & Permanent; Ac nya, English
lang ua
Pog Pe
Pe Chiampua
“Champua
( Os
“Na, Pin-75804
Tea ogigmal com
Mobile No.
Email Id:-
Aadhar no-
ee ve
EDUCATIONAL
Exam Board/University Passing (fotal Marks Marks
Div. Percentage
a Passed Slee inten ate Year Secured
Metric B.S. E,ODISHA 2019 214 36.33%
CHLS.E..ODISHA 2022
Leth se aS SUR A ELE SR me oes acai
DECLARATION
I do hereby declare that the statements made above are complete and true
to the best of my knowledge and belief.
Date:
Place: Signature of the applicant