| Particular | Description |
|---|---|
| Member ID | 1992 |
| Member Category | General Member |
| Father's Name | PRAN KRISHNA MOULIC |
| Blood Group | A+ |
| Gender | Male |
| Birthday | 1-Feb-68 |
| Date of Join | 26-Dec-99 |
| Date of Enrolment | 15-Dec-99 |
| Present Address | 155/4, D.I.T. Extension Road (Ground Floor) Fakirapool Ph:9344195, 01911268050 |
| Permanent Address | , , , , , |