1. No category

Scholarship cum Admission Test
Registration Form
1.
Name (in BLOCK CAPITALS)
: ………………………………………
2.
Father’s Name
: ………………………………………
3.
Sex
:
4.
Community (SC / ST / BC / Minority) : ………………………………………
5.
Native Place & District
: ………………………………………
6.
Date of Birth
: ………………………………………
7.
Last exam appeared
: ………………………………………
8.
Annual Income of Father / Guardian : ………………………………………
Male / Female
10. * Mobile No.
: ………………………………………
11. * Email I.D.
: ………………………………………
Paste passport
Size Photograph
here
(Furnishing Mobile No. and email I.D. is mandatory)
12. Complete Address for Correspondence
: ……………………………………………………...
…………………………………………………………………………………………………………
…………………………………………………………………………………………………………
13. Course Appearing for: Class
DECLARATION
I certify that the facts mentioned above are true and correct and I shall forfeit candidature
if any information furnished is found to be incorrect.
Place :
Date :
Signature of the Candidate.