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Name of Chairman's & Members
Name & Designation Father’s
Address Mobile
UID No. Whether member
of any other society/trust/
If answer of column 6 is yes, please furnish details
1 2 3 4 5 6 7
Atish Kumar Rout A. C Rout HIG-139, K-5, Kalinga Vihar, Patrapara, Bhubaneswar, Odisha 9437107039   No N.A.
Shailja Rout              
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