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Regd. No. 165/89 Ph: 0494-2463155, 2464502
Fax: 2460575

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Form type - A (49) APPLICATION FORM

APPLICATION
OFFICE USE ONLY

Received by : ......................................................... Payment

Remarks .........................................................................................................
Receipt No.: ........................ Date : ......................... Sign :

Roll No: 2206063 SECONDARY INSTITUTION Ref. No: 3387

Name of Student : MUHAMMED RAJIL K

House Name : KARIMBANAKKAL
Date of Birth : 28-11-2010
Name of Father : NOUSHAD
Job of Father : DRIVER
Is father your guardian? if No Why? : Yes
Name, Relation to student and job of guardian : ,,
Name of Mother : SAMEERA
BC Certified Panchayath/Municipality : Mannarkad Muncipality
District : Palakkad

Address : KARIMBANAKKAL H, NATTUKAL Po, PALAKKAD,

KERALA, 678583 PIN

Panchayath : Mannarkad Muncipality

District : Palakkad
State : Kerala
Land Phone/Mobile : 9847949877
Identification Marks 1. A BLACK MOLE ON THE BACK SIDE OF RIGHT PALM
2. A BLACK MOLE ABOVE THE ELBOW OF RIGHT HAND
Name of Mahallu : NATTUKAL JUMA MASJID8

Name of Madrassa which the student studied : HAYATHUL ISLAM

Samastha Affiliation Number and Range : 2806,TACHANATTUKARA
The Class which the student Completed :6
Reg. No of Student :

Generated On 15-04-2022 12:01:16 PM

 Did You pass Vth Class this Year? : No
No, 2015
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77 75 83
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386.00
66 85

Name of School, Completed Class : AUMLPS, VI SCHOOL, 6

LEGACY AUP

1: Darul Uloom Islamic Dawa College

2: Darunnajath Islamic Complex

Admission Options 3: Darul Irfan Islamic Academy

4: Sheikh Fareed Auliya Dawa College

5: Noorul Hidaya Islamic Academy

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Generated On 15-04-2022 12:01:16 PM

Regd. No. 165/89 darulhuda/dept.of exams 0494 2463155, 2464502

Roll No.: 2206063 Ref. No.: 3387

Name of student : MUHAMMED RAJIL K

Date of Birth : 28-11-2010
Exam Centre : Darul Uloom Islamic Dawa College,
Date & Time : 10-05-2022 9:30 am

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Generated On 15-04-2022 12:01:16 PM