Name:

Gender
MaleFemale

Date of Birth

Nationality : Indian / Other(Place Specify)

Religion: Hindu / Other(Place Specify)

Community
SelectOCBCOBCMBCDNCSCST

Caste

Name of the Father / Guardian

Name of the Mother / Guardian

Annual Income

Permanent Address with Contact No

Present Address with Contact No

Student's Aadhaar No          

Mobile Number:

Qualification UG Degree

University

Period of Study

Register No

Month & Year Passing

% of Mark

Any Physically Defects Pointed out by Medical Offer
YesNo

Are you a Member of
NSSNCCSportsOther (Please Specify)

Other Details

Your email