First name :

Father's name:

*

Last name:

*

*

Fields marked with * are mandatory

Date of Birth:

Enter Date as yyyy/mm/dd
without slashes/dots

Gender:

Age:

Permanent Address :

City :

State :

Country:

Pin code:

Telephone no :

STD Code

Phone no

Mobile No:

E-mail Id :

Personal Details :

Category :

Physically Handicapped :

Marital Status :

Details of Examination Passed :

Course name	Board/ University	Year  of Passing	Subjects Taken	Total Marks	Marks Obtained	Percentage

Demand Draft Details

Enter Date as yyyy/mm/dd without slashes/dots

DD number :

DD Date :

DD Amount :

Hereby I undersigned declare that the information furnished in this application form is true and correct to the best of my knowledge and belief. I shall abide by the decision(even the cancellation of my admission) of the admission committee,if any information is found incorrect.