Full Name of the Applicant

Email

Date of Birth

Nationality

Place of Birth

Sex

MaleFemale

Religion

Mother Tongue

Wheather belongs to S.C/S.T/O.B.C. or any other Reserved Category

YesNo

Full Name of Parent/ Guardian

Address of Parent/ Guardian

Mobile

Occupation of Parent/ Guardian

Annual Income of Parent/ Guardian

Local Address of Applicant

Applicant Mobile

Permanent Address of Applicant

Name of the School/College last attended

Qualifying Examination Passed

Month & Year of Passing

Number of Attempts

Register number of Qualifying Exam Passed