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To,
The Director,
Assam Minori�es Development Board,
R.G.B. Road, Ganeshguri, Near Sinha Lodge,
Guwaha�, 781006
Applica�on No: 2024/DER/10109900

Applica�on for the DISTRIBUTION OF E-RICKSHAW course


1. Name in Full (Block Le�er) : ASHIQUL ISLAM
2. Sex : Male
3. Father´s / Guardian Name and : SHAHJAHAN ALI
Address
Vill/ Town : GALANDI CHAHBAGICHA
P.O.: BHAKATPARA
P.S.: DHULA
Block: PUB-MANGALDAI
Dist.: DARRANG
State: ASSAM
PIN: 784190
Mobile No.: 7002324118
AADHAAR No.: 407253234514
4. Educa�onal Qualifica�on : Madhyamik
(i) HS Gradua�on Percentage :
5. Other Qualifica�on :
6. Caste : GENERAL (UR)
6. Community : MUSLIM
6. Religion :
7. Age on 1st January, 2024 : 22 years 8 months 3 days years
8. Family Annual Income : 90,000.00
9. Whether any training received : NA
for this office by your family
member
Descrip�on :
10. MCB : YES

The details uploaded above are true and no false informa�on here has been submi�ed.
Date : 22/01/2024
Place : PUB-MANGALDAI

Signature of applicant

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