Photo
First Name SHANTA
Middle Name B.
Last Name DHAKHWA
Age 36
Gender MALE
Accomadation SICKNESS
Hall Seat No
Application No 105
Foreinger (Y/N)?
Monk (Y/N)?
Student Type OLD/7
This Center Student NEW
Phone 5521188
Email
District/Country
Profession
Case Type
Severity 1
Reason GENUINE MEDICAL CONDITION
Deprature Day 2
Case Description left due to sickness.
Remarks
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