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Date of Birth

Mobile

Address

Nationality

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City

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Title of Record Attempted

Category

Description of Record

Date of Attempt

Location of Attempt

Total no of participants

Record Type

Setting New Record Breaking Previous Record

Processing Method

Normal Processing(03-04 Months) Rapid Processing(01 Month) Instant Processing(24 Hours)

Inviting Adjudicator

Yes No

Record Attemptor Signature(Head of Group/Organisation in case of Mass Attempt)

Gaurdian Signature(If Record Attemptor is a minor)