~ ~ >'>1Hl~oe' fi..rF.ro (>m=r.~.~.~) ~ >'>fHlHt •••...••...•.

~ ~
~

1.~tTOTH
2. Rr3r tT OTH
3. ROH fi-Bt
4. d<::' tdldl: f1(')dM/>m=r.m/m-.m/iRr( )
5. L(orr 1..f3T
6. F~:kl' r~>:ltT 1..f3T :

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HHw/~-~~~ ~ )')10[1
~ n

l{'"Lf3" oft3t ~I l{'"Lf3" )')10[ 'Y:3h;J3 *

I ~
tI
I t~1
~. - ---- ------ 1-----_-
II

f--~~~---
~~~~,,1J~
r--
8(')I
I

I: l..fFIZ I
I dli'lj)""" I--
I
i
I
~T
Ja
rI --------------
l J--
* l{'"Lf3" rifa Hoed Ri8k (Datail Marks) 0TFi ~ ~ ~ U?>I

8. 3f1aS tT ~ (~ famrr 3f1as'):

(fire ob--r oIT3T -=--

l...fHG orHtT~
ftww) m-rt HTW
--_. __ -_. ~**

** Completed years only

9. ~ ~ tT ~ (Hera- ~):
,-------
l --'

fi-Bt:

Hal?) :