[PROVISIONAL TRANSLATION FROM PERSIAN]

 

[Translator’s notes appear in square brackets]

[Personal information has been redacted.]

 

[Emblem]

Islamic Azad University, Shahr-e-Ghods Branch

Student Personal Information Form

 

Student ID Number: -----

First and last Name: -----

Issued in: ----

Place of birth: -----

Date of birth: ----/----/13---- [----/----/19---]

National ID Number: -----

Marital status: Single Married Divorced Widowed

Religion: Shia Sunni Christian Jewish Zoroastrian Armenian

Nationality: (name of country): ----

Home telephone no.: -----

Mobile telephone no.: -----

Home address: -----

Email: -----

 

Signature of student:

 

Address:

Fath Highway – Kilometre 20 – Shahr-e-Ghods – End of Shahid Kalhor Boulevard –

Islamic Azad University, Shahr-e-Ghods Branch