7

NATIONAL LAYi UNIVERSIIT oDISHA

ffl~ll'f: (J)f. 9,1.aznar;4.nmei'l(fian
WELLNESS CENTRE
9,1.(JJ(BS,VtiJz{ Vniversity
<BJgi. !No.: 15096/2003

eiJj 6J I Jpl l-
Name·• l •
••••••••••••••••••...::;).PC:0. •• \1..
~u f\..l~
,,, .....l I ...
{ .\.\.f.,.~
..r7M . 0
Age·..........4\ .. 4...... Sex·. ....,,
~\J .............. .Date: .. irrrrrrrn ..- • • • • ) _,...

. t.l-t~ "' .....................................

Address I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I
I I I I I I I I 11 1 I I V.
I I I I I I I I I I I I I I I I I I I I I I I I I I I I I It It I I I~- . Y . y I I t t t 111111 1 I t t t I t t t 1 1 I I I I I I

• f ;;;: - .. ":t......

~~~I.,()~',--'

() 2J,.... Dg

!. <'\) 1..- ,..,

_6 - CQ_, - , 7 ~dJ_t 'l •

9)&.,(, u
ry'\)OU,1 tm__~ ~~k'"i {(
Q11'V'

-~
ff)~-

~~,.,,.
• i~· 1~----: t \JO t ~ I L J\i

(9
Ot¼ tlL
. 'Iii~
>< ,,~~t0 ..~\:) •·~"·"-'~~ e--:~...iD"
.. .,:;
---
Iii\ , ,.'" ...
$
·- •••
----~~
hjodi Campus,.Sector-13, CDA, Cuttack-753015
Contact:0671-2338015, Ext. 5076

---