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----CANDIDATE DETAILS----

Name of Student* (Block Letters)

Father's / Guardian's Name*

Relation with Student*

AGE*

Date of Birth*

Gender*

Male Female

----CONTACT DETAILS----

Present Address (include pincode)

Contact Number

Permanent Address (include pincode)

Contact Number

Accomodation of Student

With Parent Guardian Hostel

Edcuation Qualification*

Medium*

Occupation of Father

Mother Tongue

Experience if Any

Hobbies and Othe Interest

----DECLARATION----

I hereby declare that all particulars furnished in this application are true to the best of my knowledge and belief. I have read and understood all provisions of admission and agree to abide by them. I also afﬁrm that I fulﬁll the eligibility requirements for the courses applied. In the event of submission of fraudulent, incorrect of false information of suppression or distortion of any fact like educational qualiﬁcation, marks, nationality etc., I understand that my admission i degree is liable to be cancelled.

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