INTERNATIONAL LLP

India & Abroad Educational Service

APPLICATION FORM

Name : Arifa nizar ali

Date of Birth : 16/06/2006 Gender : Male Female

Age : 18 Nationality : Indian

Blood Group : Religion : Islam

Caste : Muslim Community : Obc

Father’s Name : Nizar ali Occupation : Business

Mother’s Name : Sheeba nizar Occupation : Housewife

Annual Family Income :

Permanent Address & Pin Code : THOPPIL HOUSE, NEELIMANGALAM, PERUMBAIKADU

PO,686016,KOTTAYAM

Student Ph No : Parent Ph No :

Email ID :

Course Name : Bsc mit (radiology)

College Name : Rosy roay

Student Signature

99950 98617 www.levastointernational.com 2nd Floor, AVM Mall, Kanmani Rd, Civil lane Jn,
80890 98617 levastointernational@gmail.com Ayyanthole rd, Thrissur, Kerala, 680003