| CLUB: | Rotary club of Comilla Sunset |
| OCCUPATION: | Grocery |
| IN DATE: | …………………… |
| DOB: | ————— |
| SPOUSE: | ————— |
| ADDRESS: | Senjhalay, BESIC Road, Thakurpara, Comilla. |
| PHONE: | 01793-112011 |
| E-MAIL: | ————– |
| CLUB: | Rotary club of Comilla Sunset |
| OCCUPATION: | Grocery |
| IN DATE: | …………………… |
| DOB: | ————— |
| SPOUSE: | ————— |
| ADDRESS: | Senjhalay, BESIC Road, Thakurpara, Comilla. |
| PHONE: | 01793-112011 |
| E-MAIL: | ————– |