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APPLICATION FORM

(for undergraduate programmes under cbcss)

Course applied for*

Name of the Applicant *

Date of Birth*

Sex*

Blood Group *

Caste *

Religion *

Sub Caste *

Place of Birth *

Nationality *

email *

PERMANENT ADDRESS

Address

District*

state*

Pincode*

COMMUNICATION ADDRESS

same as above

Address

District*

state*

Pincode*

Father's Details

Father's Name*

Official Address

Designation*

Pincode*

Residential

Mobile*

email *

Mother's Details

Mother's Name*

Address

Designation*

Pincode*

Residential

Mobile *

email *

Name and address of the Schools last attended

SSLC*

PLUS TWO*

OTHER*

Educational Details. (all the details must be filled)

	Subjects	Marks secured	Board	Register No & Period of Study	year of passing
SSLC	Write only total marks for all subjects together
Plus Two	Part I English
	Part II (Language)
	Part III Optionals
	1.
	2.
	3.
	4.
	5.
	Tottal

I undertake to state that the information furnished above is true to the best of my knowledge.

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