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APPLICATION FORM

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    USE CAPITAL LETTERS ONLY

    Course Applied for *

    Under University

    Name *

    Middle Name

    Last Name *

    Date of Birth


    MM/DD/YYYY

    Father's Name

    Mother's Name

    Present Address *

    Pincode *

    Permanent Address *

    Pincode *

    Phone No. i *

    Phone No. ii

    Land Line No.

    E-mail *

    Caterory

    GeneralSTSCOBCOthers

    Status of 10th Examination For Diploma

    PassedAppeared

    Year:

    Status of 10 + 2 Examination For Bachelor Degree

    PassedAppeared

    Year:

    Status of Graduation Examination For Master Degree

    PassedAppeared

    Year:

    Sex

    MaleFemale

    Academic Stream *

    ScienceCommerceArtsVocational

    Hostel Required

    YesNo

    Affix latest stamp size colour photo with signature

    Declaration *

    I hereby declare that, the particulars furnished above are true and correct to the best of my knowledge and belief. After carefully going through the entire content of the prospectus and fees structure, I agree to abide by the terms and conditions imposed for taking admission in the aforesaid course.

    Remarks

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