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GIVEN NAME (Full name not initials) :

SURNAME:

DATE OF BIRTH:

PLACE OF BIRTH : (VILLAGE)(STATE)

GENDER:	Male Female

MARITAL STATUS:

EMPLOYMENT TYPE:

IS YOUR PARENT OR SPOUSE, A GOVT SERVANT:

EDUCATION QUALIFICATION:

FATHER NAME: (Full name not initials)

MOTHER NAME (Full name not initials)

LEGAL GAURDIAN NAME : (If Applicable)

SPOUSE’S NAME: (If Applicable)

PRESENT RESIDENCE ADDRESS:

RESIDING SINCE: (MONTH & YEAR)

VILLAGE:

DISTRICT:

STATE:

POLICE STATION:

PIN CODE:

MOBILE NUMBER:

EMERGENCY CONTACT DETAILS

FIRST REFERENCE ADDRESS & CONTACT NO (NEIGHBOR’S ADDRESS)

SECOND REFERENCE ADDRESS & CONTACT NO (NEIGHBOR’S ADDRESS)

PREVIOUS PASSPORT DETIALS: (IF APPLICABLE) PASSPORT NUMBER: ISSUE DATE: EXPIRY DATE: PLACE OF ISSUE:

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