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Application Form: To Be Filled in CAPITAL Letters Only

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APPLICATION FORM

POSITION APPLYING FOR: SPECIALIZATION (if any): To be filled in CAPITAL letters only 1. Candidates Name (As given in Class 10 Certificate):
th

Paste Recent Photograph (Do not staple or Pin)

2.

Date of Birth: D D M M Y Y Y Y 5. Nationality: ST OBC

3.

Gender:

4.

Marital Status: GEN

Single / Married SC

6. Category: 7.

OTHERS

(a) Fathers / Guardians / Husbands Name:

(b) Mothers Name:

8.

Fathers/ Guardians/ Husbands Occupation:

9.

Annual Family Income (Rs.)

10. Permanent Address:

E-mail ID 11. Educational Qualification (Start from the highest qualification first): Title of Degree / Name of Board / Year of Name of School / Qualification University Passing College / Institution

Overall Marks (% of Grade

Major Subjects

DECLARATION BY THE APPLICANT 1. 2. I hereby declare that all particular stated in this application are true to the best of my knowledge and belief. I have read and understood all the provision of the prospectus and agree to abide by them in the event of suppression or distortion. I am fully convinced with all the information given in the information and understood all the rules and regulation.

Signature of Applicant

Signature of Parent/Guardian

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