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Instron: Al deta to be lad (be wold for3 month for date of)
Tobe printed neon poverse; tobe priedon tebe: ‘ Oo 63] Bezy
Non-Resident indian (NR) New Enrolment Update Request
ttm = [ID 7k CE OF 39
Fut Name: ewarArovoA VvVewkATA ,
Iwaga AI NZwHAL
Co: RAGHAVENDRA R Ao
Houseno/siie/ act: [p af O Qi- ios iil FLATNO-5&
Street/ Road/ Lane: [¢ RT vewk ATESWAR A WilAyAn
Landman: Beeisiz Oe SAT BABA TE mPLE
Areaflocaiy/tecon [WT SIA UA kKi¢h T N'A G AIR
Village/ Town/ City: CMT i wiviAi gi ain tz
Post Office:
District: Mages: [Ai KIN EAP Air iv
State: AnwowrkAPRA DEH
ty
PIN Codes Siz O10 Ys ea er
oat tu desiB oe. 7) | sansa
Certifier’s Details {To be filled by the certifier Only)
Name of the Certifier DQ. pAS HOR LUMAR
Designation: civic svRGeEon
Office Address: PROF OF ORTHOPEDICS
AMG/EAH VISHA 165 PaTRay
comanmbe: [pgq]—24e24e)_—~«dz
ay es wena cl vidi he
(Tick appropriate bex below) iio overwriting (peaeie is filled ‘etifier's details
Gereted Offer Group A Lf crmteerelli epee amped epee
ED vittage Panchayat Head or Mubhiya
Gazetted oftcer -Group 6
[Emer naa satc/ Municipal counciior
i tensidor
Dy Head of Recognized Educational institution
Gr supeitensen/ Warder Matron Head of stun
of ecogied sheer tones Orphanages
TD erro otter
cmon ‘Visakhapaisa™-
‘Tobe used as Proof of deny Po) ony inspect cases as mentioned inthe tof appleable supporting documents