For Encyclope dia Indica Shiaii
Brief Account
Present & Past Imamia Calligraphers, Painters & Photographers
Please attach passport size photograp h
Name…..---------------------------------------------------------------------------------------------------------------------------------------------------------------------Father's Name………..-------------------------------------------------------------------------------------------------------------------------------------Date & Place of Birth…………………………--------------------------------------------------------------------------------------------Teachers………..----------------------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Qualifications…………..----------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Profession……-------------------------------------------------------------------------------------------------------------------------------------------------------A Brief Account of creations/Designs…………………………………………..--------------------------------
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Office Address…………….---------------------------------------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Local Address………..--------------------------------------------------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Permanent Address………-------------------------------------------------------------------------------------------------------------------------------
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Office Phone………………-------------------------------------- Home Phone…………….------------------------------------E-mail…….--------------------------------------------------------------------------- Mobile…………---------------------------------------------Date of Expiry…………………---------------------------------------------------------------------------------------------------------------------Place of Death…………….-----------------------------------------------------------------------------------------------------------------------------Place of Burial…………………---------------------------------------------------------------------------------------------------------------------Chronogramme (Tareekh) of death……………………………………..-----------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Source……---------------------------------------------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Name, address, phone nos. etc of person reporting…………………………………..---------------------
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Signature
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Date
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Place
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Note:- Plz. attach also a post-card size or larger 'full length' photograph Plz. use separate sheet(s), if necessary
Noor-e-Hidayat Foundation Imambara Ghufranmaab, Maulana Kalbe Husain Road, Chowk, Lucknow-3 Mob: 09335276180 Ph: 0522-2252230 - 0522-4062731 E-mail: noorehidayat@yahoo.com noorehidayat@gmail.com website: www.noorehidayatfoundation.org