Reg No

Photo: (Upload JPG,PNG and GIF Image Only)

Name of Applicant

Expansion of Initial

Date of Birth
Age

 

Sex

Select Male Female Transgender

Mobile

E-mail

Mother Tongue

Blood Group

Nationality

Religion & Community Name

Details of Parents

DETAILS	FATHER	MOTHER
NAME
QUALIFICATION
PERMANENT ADDRESS
PHONE NO
EMAIL ID
ANNUAL INCOME

Name of the Course

Name of the School & Address

Medium of Instruction

RN No with Date

RM No with Date

Extra Curricular Activities participated Sports / NSS / NCC / Others (Specify):

Year of Experience & Institution Name

Form Date:

To Date:

Details of Marks Obtained:

	Total Marks	Percentage
1st Year
2nd Year
3rd Year
Total

Amount :

₹1550

Marksheet: (Please attach your All 3years marksheet to be upload in PDF format )

    I hereby declare all the above information are true to the best of my Knowledge.

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