For Encyclope dia Indica Shiaii
Brief Account
Present & Past Imamia Freedom-Fighters
Please attach passport size photograp h
Name…….---------------------------------------------------------------------------------------------------------------------------------------------------------------------Father's Name………….------------------------------------------------------------------------------------------------------------------------------------Date & Place of Birth………………………..--------------------------------------------------------------------------------------------Teachers……….------------------------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Qualifications………….----------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Field(s) of Operation…..-----------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Field of Leadership…………--------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Arrest, Confinements, Punishment, Sufferings……………………………..---------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Political Fight……………---------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Party to which attached in sacrifice for nation's freed….---------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Date of Martyrdom/Death……………………….---------------------------------------------------------------------------------------Place of Martyrdom/Death and Burial…………………………………………-----------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Reason for being unknown----------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Chronogramme (Tareekh) of death/martyrdom…………………………………………………------
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Source…..--------------------------------------------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Name, address, phone nos. etc of person reporting……………………………………---------------------
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Signature --------------------------------------Date --------------------------------------Place --------------------------------------Note:- Plz. attach also a post-card size or larger 'full length' photograph Plz. use separate sheet(s), if necessary
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