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Name (in block letters) *

Expand initials (if any)

Age *

Date Of Birth *

Gender *

Blood Group

Nationality *

Religion & Community *

Alloted Category

Caste & Sub Caste

Father's name

Mother's name

Present Address *

Permanent Residential Address *

Phone No with STD code (Parent) *

E-mail *

Name & Address of Guardian (if any)

Occupation & Annual Income of Parent/Guardian *

Name of Entrance Exam (if any) Appeared with Score

International Industrial Visit *

Upload Your Photograph *

Upload Your Signature *

Photo Must be in Passport (PP) Size. Max Upload Size 256KB

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