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Personal Details
Course Applied For
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Full Name
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Date of Birth
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Pick Date
Gender
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Male
Female
Permanent Address
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PinCode
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Parents / Guardians Occupation
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Contact Number
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Office:
Residence:
Mobile: +91
E-Mail
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Education
Sr.
Exam Passed
Year
Board / University
School / College
Maximum Marks
Obtained Marks
Percentage (%)
1.
Metric
Select Year
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
2.
10 + 2
Select Year
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
3.
B.A.
Select Year
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
4.
B.Com.
Select Year
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
5.
B.Sc.
Select Year
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
6.
Degree Course
Select Year
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
7.
Any other
Select Year
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
Other Details
Do you have any physical disability
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Yes
No
Blood Group
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:
A
+ve
A
-ve
B
+ve
B
-ve
AB
+ve
AB
-ve
O
+ve
O
-ve
*
I hereby declare that the personal information given in this form is true and that no material information is willfully suppressed by me. I stand to be disqualified to being admitted to the institute in the event of my being found to have false information. I hereby agree to abide by the rules and regulations made from time to time.
Date :
Place
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(Cadidates' Name will be used as declaration Signature)
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