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Student Name ( In Bengali) :

Student Name ( In English) :

Father Name ( In Bengali) :

Father Name( In English) :

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Mother Name ( In English) :

Mother's Occupation :

Father/Guardian's Annual Income :

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Religion :

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If Government Scholarship Earned

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Memorandum No. :

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SSC/Dhakil Exam Result

Group :

Obtained GPA ( With Fourth Subject) :

Obtained GPA(Without Fourth Subject) :

Reading Subjects ( In Class XI)

a) Bengali

b) English

c) Information and Communication Technology

g) Fourth Subject :