Batch : 201.......201........
Name of the Student :
Date of Birth :
Gender : Male ( ) Female ( )
Occupation :
Mobile no.: E-mail:
Category : SC ( ), ST ( ), OBC ( ), EWS ( ), GENERAL ( )
Postal Address :
City District Pin
Marital status : Married ( ) Unmarried ( )
Academic Record University/Board Degree Year of Percentage Division
Passing
10th
12th
Graduation
Masters
Others
Declaration by Student
I declare that all information in this application is complete, factually and honestly correct. I
promise to fulfill minimum 80% attendance in all the classes throughout the session. I have read the
rules and regulations adhere an abide by the same. I shall remain disciplined in the campus.
(Signature of the Student)