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Applicant Registration Form :-
Course Applied For
:
Applicant Name
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Father's Name
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Mother's Name
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DOB of Applicant
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DD
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MMM
Jan
Feb
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Apr
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June
July
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Oct
Nov
Dec
YYYY
1972
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1989
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Postal Address
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City
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State
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Country
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ZipCode
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Email ID
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Mobile No.
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Telephone No.
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Category
:
Select
General
SC
ST
OBC
Gender
:
Male
Female
Educational Qualification :-
Exam Passed
Board/University
Name of School/College
Year of Passing
Percentage
10th
Year
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
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2006
2007
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2010
2011
2012
12th
Year
1990
1991
1992
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2003
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2011
2012
Graduation
Year
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
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2001
2002
2003
2004
2005
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2007
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2011
2012
Post Graduation
Year
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
Other
Year
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
MAT/CAT Percentage
Month :
MMM
Jan
Feb
Mar
Apr
May
June
July
Aug
Sep
Oct
Nov
Dec
Year :
YYYY
2011
2012
Score :
Percentage :
Whether hostel facility required
:
Yes
No
Work Experience
:
Other Achievements
:
Payment Details of Registration fee Rs. 1,000/- (if payment has been already made)
Payment Mode
:
Select
Cash
Cheque
DD
Bank Transfer
Payment Date
:
Cheque / DD / Trans No
:
Cheque / DD / Trans Date
:
Bank Name
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I hereby declare that the above information is true to the best of my knowledge and belief. I further understand that any false statement or intentional omission will render me liable to prosecution. I hereby also agree that I will obey all rules and regulations of the college and shall abide by all decisions of management.
Security Code
:
Enter the code
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Feb
2012
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Feb
2012
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Feb
2012
Visit to Asan Barrage
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Journey Arrangement Form
Medical Certificate
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