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Application For Admission 2019

Course applied for
(Each application shall be used for only one course)

Photo

Name (in Block Letters)

Sex

Date of Birth (DD/MM/YYYY)

Age as on (31-12-2018)

Name of Father

Name of Mother

Religion

Community

Mobile No

Phone No

Permanent Address

Address for
Communication


Details of Qualifying Examination (To be supported by Self attested copies of mark lists and certificates)

H.S.E. or
Equivalent.
specify

University/Board

Register Number

Year & Month


Marks Obtained

Subject

Maximum Marks

Marks Secured

Percentage

No. of Chances

Physics

Chemistry

Biology

Mathematics

Computer Science

Biotechnology

Total Marks

Annual Income of the Family

Rs

If the candidate is claiming any reservation or other benefits furnish details (Y/N)

DD No

Date (DD/MM/YYYY)

Bank