aig aouihend ond: Mal MJAlayvesoW aldrJaj, COB Wdan06 6a0g MoMLO09M MIaUOMoMlaUAd GoEmo019) apafl anal wéghilaag cassad picaMMamlnjgs ancalasi96.0900 2018-19 eanmiantdismlacs mdeznemss \navrnyda)> anwlas anqylenastmalnjenaie ealans aeataarercro2 anolgjlcanmesi. amgow aiaivemss caraayqwa} enomamh} ancwrnymmDD! aMarcaa;mooa. MrcalaMed/sDeniasanjas cud (aormoganres) (Name in Malayalam) An Passport 1) ) tsordedexcdend 7] Se gorau (wy [7] anatonndg nad (Doggailed) 5 orton ea09e50 Full Name (in block letters) ansmo cudlonow cacdaleioms alltdeaons masloe (Permanent address with Pincode) Bass} Msammakn}so Allenm aildaaons massa (Address to which communications are to be sent with pincode) eocéeu} exnomnd (Land phone) annoend mid eaoulmantoe (Phone number with code) ‘929996N108 (Mobile phone) mgyor}/oseedamoaiod cud (Name of father/guardian) many said (Name of mother) Gneaseaiean 190010 (Nationality) = Gocaiaasaan} amosad (Occupation) =10.1 avomunome 10.2 silgy (State) (istrict) 103 emypes 104 wnooumnnomiod cars (Block) aywimIgpalgajas end eaodnucoason Gass (Name of Grama Panchayath/Municipaiity/Corporation) 11. aque, ammmlaatay> otioefl coms atta (Age & Date of Birth) zs) 12. a0 (Religion) 20001 (Caste) 124 again 12.2 apad.st 123 genta | 124 apiatansemd — (so) wn coBc) (Other Communities) GHMeMoE\aoWDA cool (V) GMSWOBo gS} (Put tick (v) mark whichever is applicable) 13. aidlyoloymornjas answogensd aM (Identification marks) @) 14, alayoayory ewonyn (Educational Qualification) 141 a1amo0@n0/a00d orencwel ayEyooauclmo0l aqesmo?r oxen 7 emg 142 aasameiiad asomeanicno audio « 143 max@ alayoductwoesmo ayers mg) 144 aasametad aga ord 145 mayor} caiojo alenmvayo 15. acta cmsayoton} aiiosao%eo (Details of fee paid) 15.1 mje coesamies (seaaoaens ) (Amount Rs) (in words) 15.2. sive: (Bank) 153 \mnbosal (Branch) 184 oaseiond mod 155 ovroo! (Date) 16. areniosiocd omjpos /aimowors/ajoavigjveigl/ caodaseoatd Gn0ess nom! Quowovrlal noo [] ong os qys said afleanamiatag|smoaamot Yes No (Whether the applicant belongs to Project Fund Category)161 caneds aomi comyarilay e505 ramoDons /ayMoIgjoeNgl/ ca0Baleoauor aid (Name of Block! Panchayath/Municipality/Corporation) 17. oBqYS oaiti@ alarom/msdaiaso eaLBaMOd} Gnso}o cadiaierrmvajo (Name & address of the CECINCEC where registration has done) 18. asdlooallom aelqyd satin crioslamasy ayaa alosoonendd 18.1. o(ninastor aid (Name of Prerak) 182. aileamomaiass0eic0/ sA0i19}008400 (NCECICEC) 18.3. cyuoaitog aaj (Signature of Prerak) awmsaroainyeto agin amacd agyormaayolay jase saosjaMlalaaM alaioaBd apaq} arolaileys alo1~DaMleys cmsaosammn} porlmoed (aimSmoalyoaoa8}00), runeto (Place) Name & Signature of Applicant 10! (Date) MHenIaMU}IS/MEASHHH Gainjo Agio oy onl Gard: Gass Blgp cas-ardaulengs Wayw8 cowaaa aneiauoled pvdranoraleananea 1 Chal aolmrsyolog sas (oslmiesaud aolay gvogjos) - (KSLMA Copy’ apa comion|sjaoIdlasjm saieso%8) 2. MEalaMODS eiohasjM an9eg9 TUKD TIAMJO_Is]omIOR. 3 BOMolaD, alayosymemsno angalajMalnjas Tésholeng TIM. Moeao9js}omIM oe8ql. MHEsAUDlOe aE GAIAJo S\Oja001 ayolaflalalansms. aydamaowl aljolaflaslsleranayo MAKM\2OD Coals DEHAMHJ200 GoEniaM TMadlenMag mmeniaaoerooncaMIaSoyJo Caldamlsjas oeloisand Méghclang ayelasla} womenind$ oomvad can0eg9 aumlessore mon}. oalale.saand wdglclaagled asloajIM cacres) MIoa}oJ5}comsramIGI, cocniass osiTys oargyT goad 25 olalywaymoxmmy> SI oxAlaicisaund Mdsholan} ceased ajcailesaaremnoan. 220g]: Dersaahaajanaadd DeyMIn/IOoaT ani pelos qvaseomoalewnd eg” car- Ma, oss2dicIwons peta GoId Majd aaw2aMD}> GerlaH2ea0200D103 M225 aysjeomaemoa. af anéniaKn}0s Merio2serLIVEHSIS ego ca-dadnvIEnga, M'ajd0 enwo0 apamlard aq] anicasmeolgs