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2021-12-10T11:41:26+00:00
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Profession
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Company/Institute Name
Company/Institute Address
Name
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Phone
Email
D.O.B.
Father's Name
Father's Occupation
Father Mob.No.
Current Address
Street Address
City
ZIP / Postal Code
Permanent Address
Street Address
City
State / Province / Region
ZIP / Postal Code
Date of Starting
Date of End
Height
Weight
Blood Group
A+
A-
B+
B-
O+
O-
AB+
AB-
Married Status
Married
Unmarried
Floor
Ground Floor
First Floor
Second Floor
Room No.
Bed-Type
Single Bed Room
Double Bed Room
Triple Bed Room
Dormitory
Available Facilities
Bed No.
Bed Sheet No.
Pillow
Pillow Cover No.
Bed-Table No.
Bucket+mug No.
Bath-stool No.
chair No.
Local Guardian
Guardian Contact No.
Guardian Address
Registration Amount
Fees Deposite Amount
Fees Deposite Date
Fees Balance Amount
REFERENCE
Amount (Per Day Basis)
Rs. 349/-
Rs. 399/-
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