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(In English, Capitals)- First Name, Middle Name and Last Name (Surname) 2. Sex: 3. Male/ Female Date of Birth : DD MM YYYY Age as on 01.07.2015: (Proof for Date of birth to be enclosed) Marital Status: Married : 4. Father s Name: Unmarried Others (Specify) 5. Name of the Spouse: 6. Category (indicate by marking X in the appropriate box)(Proof to be enclosed) S.C. S.T. O.B.C. GENERAL Are you an Ex.

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