Independent Nation

West Town Kalikapur, Post, Thana& Dist: Patuakhali 

Admission Form

               

Id:

                                                                                                     Photo

Name                        :.............................................................................................................................................................

Father’s Name        :..............................................................................................................................................................

Mother’s Name        :..............................................................................................................................................................

Date of Birth        :..............................................................................................................................................................

Present Address        :..............................................................................................................................................................

Permanent Address:..............................................................................................................................................................

Mobile Number        :..............................................................................................................................................................

Religion            :...............................................................................................................................................................

Nationality                :...............................................................................................................................................................

Occupation                :...............................................................................................................................................................

Highest             :...............................................................................................................................................................

Weight              :...............................................................................................................................................................

Hobbies            :...............................................................................................................................................................

Interest                   :...............................................................................................................................................................

Blood Group         :...............................................................................................................................................................

Education          :...............................................................................................................................................................

I am applying for membership of Independent nation. I agree to abide by the rules of Independent nation. I declare that the information given above is true and correct to the best of my knowledge.

                                                                              Chairman      

Applicant                                                       Independent Nations