| CLUB: | Rotary club of Comilla Sunset |
| OCCUPATION: | ————— |
| IN DATE: | ……………… |
| DOB: | 02 Mar. |
| SPOUSE: | ————– |
| ADDRESS: | Satgaria, Chouddagram, Comilla. |
| PHONE: | 01714-373323 |
| E-MAIL: | ————— |
| CLUB: | Rotary club of Comilla Sunset |
| OCCUPATION: | ————— |
| IN DATE: | ……………… |
| DOB: | 02 Mar. |
| SPOUSE: | ————– |
| ADDRESS: | Satgaria, Chouddagram, Comilla. |
| PHONE: | 01714-373323 |
| E-MAIL: | ————— |