Selected Course:
Name of the Candidate in English alphabet(in block letters)*:
Date of birth:
Gender:
Category:
Father's Name:
Mother's Name:
Parents Telephone/Mobile No:
Nationality:
Mother's Tongue:
Name of Institution last attended :
Address of Institution :
Name Board/Council last attended:
Present Address *:
Present District *:
Pin:
Tele/Mobile No *:
Same As Present Address
Permanent Address:
Permanent District *:
Pin:
Tele/Mobile No:
Email: