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Flood Victims
  1. Your Name(*)
    Please let us know your name.
  2. NIC Number(*)
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  3. Your Email(*)
    Please let us know your email address.
  4.  
  1. Victim(*)


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  2. Admission No
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  3. Staff ID No
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  4. OBA Membership No
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  5. Associated Group or Batch
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  6. Recipient Name
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  7. House

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  8. Recipient Address
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  9. Recipient Current Address
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  10. Recipient Contact No.
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  11. Date of birth
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  12. Age
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  13.  
  1. Number of family members
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  2. Number of family members affected
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  3. Name and Age of affected Family Members
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  4. Urgently Needed Assistance




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  5. If any other please specify
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