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ASA International India Microfinance Pvt. Ltd.

Victoria Park, 9​th​ floor, GN-37/2, Sector-V, Salt Lake City, Kolkata-700091

 1​. Name in full


_______________________________________
_______________________________________

Nick name______________________________

2. Father's name_________________________________

Mother's name_________________________________

3. Place and Date of birth_____________________________

_______________________________________________

4 Language spoken_____________________________________________

____________________________________________________________
5. Permanent Address: _____________________________P.O.___________________
P.S._____________________Dist.___________________ Pin. _________________

6. Qualification:
Degree Institute Name Board/University %age acquired Year

7. Particulars/details of Ration card/Driving License/Identity Card


__________________________________________________________________
8. Name and Address of surety/Guarantor
i. ______________________________________________________________
______________________________________________________________
ii. ______________________________________________________________
______________________________________________________________
iii. ______________________________________________________________
______________________________________________________________

9. Name and Address of previous employers (if applicable) ________________________


_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
10. Source of information about employer/employment vacancy
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

11. Any criminal record?


_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

12. Personal Description:-

i) Height ____________________________

ii) Build _______________________________

iii) Hair __________________________________

iv) Complexion _____________________________

v) Tattoo Marks_______________________________

vi) Other Identification Marks ____________________

vii) Deformity or peculiarity if any __________________

13. Cycling

Date:

Signature:

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