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Registration Number:
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Course Applied for:
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Name (Mr./ Ms.)
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 Name of Father (Mr.)
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 Name of Mother (Mrs.)
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Date of Birth
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 Aadhar No
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 Nationality
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Category:
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 Religion
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 Caste
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Minority
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 Gender
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 Marital Status
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Physically Handicapped
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 Father’s Occupation
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 Mother’s Occupation
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Address for Correspondence:
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 City
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 State
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Pin
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 E-mail id
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 Permanent Address
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City
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 State
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 Pin
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Father / Mother (Mob)
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 Student (Mob)
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 Mobile No. For SMS (Alert)
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Educational Qualification:
Examination Name of Institution Board/University Year Maximum Marks Obtained Marks Subject
Secondary
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10+2
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Graduation
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Sports Achievements/Awards/Participation
National Level
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State Level
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Declaration by the Applicant I Mr. / Ms.
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 hereby declare that the information furnished in the form is true to the best of my knowledge and belief. I promise to abide by the rules and regulations of the college.
Date
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Signature
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