Student Name *
Date of birth *
Age *
Upload photo *
Community *
Caste *
Nationality *
Religion *
Father's Name *
Aadhar Number *
Communication Address *
City*
District*
State*
Pincode*
Mobile Number*
Email*
Name of the school/Institution Last studied*
Year of passing*
Percentage of Marks in 12th Standard*
I declare that the particulars furnished above are correct and that I will abide by the rules and regulations of the Institution
Signature of the candidate *
