Full Name of the Candidate:

Father's Name:

Mother's Name:

Phone No:

Address:

Date of Birth & Place:

(as per S.S.L.C. Marks card & T.C.)

Nationality:

Religion/ Caste:

Name and Address of the School last attended:

Total Marks obtained in S.S.L.C.(in %):

Medium of Instruction:

Subjects opted in PUC:

Languages opted:

Email Id:

Δ