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Om. Ch, oer dan Nome ry Fate Name: ‘Guardian Name For minor ony: IM Cm Om. lower Date of i Pace of Birt Country oF Bir: ‘Gander: C]Mele ]ramah Jtranepender Nonaty: Maral Sates: CIMarios Junmaried Coton Spouse Name (Ronuired t Maral Status s Marie) PAN No. Form 60: ‘Asdnaat No: (opsona) Pto10c Card No: (Roque #20 ar holarg PION car) EMIT ‘Address Type: ]Resdertalor Busines []Rasientsl CJeusinse JRapatees once Junspacsae CtyrTowoisie. state. Pi county: Permanent Address [Lanse tek) #Pemanen& Curent ross ae same (n such ae, ro spate rot ofporanet aes equa) ‘Adaress Type: []ReedentalorGuriness [JRescanta! [uses []Repetoas Oe []Unspactn CtyrTowoiste. state. Pi county: Please tick whore you woud Ike to racloveallcoraspondences [|Current Address ["] Permanent Adress Mob. No Tok. Nos) Tal Nosor) Fax 29 S88 NUNES pi adiresss arty tomer Banting regen oT Passport Ne Issue Date ce of ese Nationally ‘Vai upto “Vie Work Pari No. enue Date Place ofterue ‘atl upto Identification Detals (s 1) root ot Se 2) Pret toy Prot tT Resin (6) Catt Ades document (Ove ony ©) Prot ot Permanent ress (Overseas ian 1) Astor poo oon tce doce cutaner: For appltant whois nt visting ou Branch or epaning the acount hid party atetation by anyone oh autores eatat se1Forign ofco——[]Netay Pubic [inden Ebasy or igh Comission ST ETE 8 ax enfetion Number (N) Plese provide aren IfSNo fle n Texan Detall [| county otresisenceortax | T*enifetion Number IM) | rH esuing County unetiona ual [sane as curantadsrass ]same 2 ty a Sate Ph county. 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