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SAMYUKTHA SWAKULA SALI SANGHA® Affix
Pass Port
Reg. No. 900/04-05 size Photo
162, 3rd Cross, 20th Main, BTM Layout I Stg, BANGALORE–560068
Office: 26783295/Mobile: 9845035334
E-Mail: ssss.vadhuvara@gmail.com
ªÀzsÀÄ-ªÀgÀ ¸ÀªÀiÁªÉñÀ-2011 / Vadhu-Vara Samavesha-2011
Cfð £ÀªÀÄÆ£É / Application Format
Regn. No. /£ÉÆÃA.¸ÀASÉå F/M/W/D
ªÀzsÀÄ / Bride □ ªÀgÀ / Groom □ Tick√ Box Widow/Widower □ Divorcee □
ªÀzsÀÄ/ªÀgÀ ºÉ¸ÀgÀÄ WÀgÁuÁ
Bride/Groom Name Surname
vÀAzÉ/¥ÉÆõÀPÀgÀ ºÉ¸ÀgÀÄ vÁ¬Ä ºÉ¸ÀgÀÄ
Father/Guardian Mother’s name
d£Àä ¢£ÁAPÀ ªÀAiÀĸÀÄì JvÀÛgÀ
Ft. Inch
Date of Birth Age Height
ºÀÄnÖzÀ ¸ÀܼÀ ºÀÄnÖzÀ ¸ÀªÀÄAiÀÄ gÀPÀ Û UÀÄA¥ÀÅ
Birth Place Birth time AM/PM Blood Group
d£Àä gÁ² d£Àä £ÀPÀëvÀæ/¥ÁzÀ
Birth Rashi BirthStar/Pada
«zÁå¨sÁå¸À GzÉÆåÃUÀ
Qualification Occupation
ºÀÄzÉÝ ªÁ¶ðPÀ ªÀgÀªÀiÁ£À
Designation Annual Income
«¼Á¸À: ªÀÄ£É/Residence «¼Á¸À: PÀbÉÃj/Office
CtÚ-vÀªÀÄäA¢gÀ ¸ÀASÉå CPÀÌ-vÀAVAiÀÄgÀ ¸ÀASÉå zÀÆ. ¸ÀASÉå/
No. of Brothers No. of Sisters Ph.No.
E-mail:
DAiÉÄÌ/Choice
Preferences
Attachments Passport D.D. Amt.
Tick Box √ Photos
□ 2 Nos. (1+1) D.D.No.
- in Rs.
□ 500 □ 600 □700
No. of persons attending the
function: Tick box √ □ Parents/Gaurdain (Two Max) Guests: □ One □Two
I, the undersigned, Father/Guardian of Vadhu/Vara, hereby agree to the rules of Samavesha.
¸À»/Signature ¢£ÁAPÀ/Date