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Course*

Name of Applicant (in English)*

(In capital letters as per High school certificate)

Father’s Name

Mother’s Name

Date of Birth

(As per High School Certificate)

E-Mail

Sex

Nationality

Caste

Category

Permanent Adress

Phone Mobile*

Address for Correspondence

Landline No. Mobile

Local Guardian, if any, with address

Landline No. Mobile

Blood Group

Medical Problem

School/College/University last attended

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