कर्णाली प्रदेश प्रतिनिधि फारम

Name*

Email*

Phone Number*

Date Of Birth*

Blood Group ---A+A-B+B-O+O-AB+AB-

Representation From*: ---Province CommitteeDailekhDolpaHumlaJajarkotJumlaKalikotMuguSalyanSurkhetWestern RukumNominee

Permanent Address

District* ---BhojpurDhankutaIlamJhapaKhotangMorangOkhaldhungaPanchtharSankhuwasabhaSolukhumbuSunsariTaplejungTerhathumUdayapurBaraDhanusaMahottariParsaRautahatSaptariSarlahiSirahaBhaktapurChitwanDhadingDolakhaKathmanduKavrepalanchokLalitpurMakwanpurNuwakotRamechhapRasuwaSindhuliSindhupalchokBaglungGorkhaKaskiLamjungManangMustangMyagdiNawalpurParbatSyangjaTanahunArghakhanchiBankeBardiyaDangEastern RukumGulmiKapilvastuPalpaParasiPyuthanRolpaRupandehiDailekhDolpaHumlaJajarkotJumlaKalikotMuguSalyanSurkhetWestern RukumAchhamBaitadiBajhangBajuraDadeldhuraDarchulaDotiKailaliKanchanpur

Rural/Municipality*

Ward No.*

Temporary Address

District* ---DailekhDolpaHumlaJajarkotJumlaKalikotMuguSalyanSurkhetWestern Rukum

Rural/Municipality

Ward No.*

Nepal Engineers' Association No.*:
Party's Organized Membership No./Issued Date: (Please mention"PUP"for those who are from Party united process.)

BE
College Name/Faculty/Passed Year*
ME
College Name/Faculty/Passed Year
PhD
University/Domain/Award Year
Current Work
Position/Organization/Year of Experience

Party Work Experience in Brief

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