(To be filled in by the candidate in his/her own handwriting in BLOCK letters only).
1. Full Name of the candidate as in the SSLC/H Sc Record
2. Course Applied for
3. Date of birth
4. Gender
5. Regiion and Caste
6. Category
7. Aadhar No.
8. Nativity.
9. Nationality.
10. Mother Tounge
11. Blood Group.
12. Permanent Home Address.
12.1 Pincode
12.2 Telephone No
13. Address to which communication should be send with contact number
13.2. Telephone No
14. Email Address
15. Name of parent or guradian (State Relationship)
16. Name of local guardian, if any (with telephone No)
17. Academic Qualification:
Subject:Main & Sub
Mark Secured
% of mark Secured
Year of passin.
Register No
Date & authority issuing it
Institution/University
Marks
0% of Marks Secured
Name of examination passed
Date & authority issuing it.
I hereby declare that all particulars stated in this appliction are true to the best of my knowledge and belief. I have read and understood all the provisions of the prospectus, and agree to abide to them. In the event of suppression or distortion of any fact like educational qualification, Nationality, Study periodic etc., made this application form, I understand that my registration/admission is liable to be cancelled at any stage.
Date :
Place :
Signature of Applicant :
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