Minority Application Proforma2015

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APPLICATION FOR LEFTOVER SEATS IN MINORITY COLLEGES

NAME OF THE CET APPLYING


APPOLYCET/APECET/APICET/APEAMCET(MPC/BIPC) –2015

S.No. Name of the Field


Details furnished by
candidate
1 Name of the Candidate

2 Father's Name

3 Date of Birth

4 Sex

5 Caste Category

6 Minority: Muslim/Christian/

POLYCET-GPA IN 10TH CLASS


ECET- DIPLOMA MARKS /
Marks obtained in qualifying
TOTAL MARKS
examination/Total Marks
7 EAMCET- INTER GROUP MARKS /
(Intermediate/Diploma/Degree as
applicable) TOTAL MARKS
/MAXIMUM MARKS
ICET-DEGREE MARKS / TOTAL
MARKS
8 Region (AU/OU/SVU)

9 Year of passing qualifying examination

SSC/Equivalent Exam Hall


10
Ticket Number, month and year passing
Demand Draft Number/Name of Bank/
11
Amount / Date

12 Mobile Number

13 Email Address

14 Address for Communication

15 Aadhar Card Number

DECLARATION
I declare that the Information given above is correct to the best of my knowledge and
belief. I am aware that I will be considered for leftover seats in minority colleges only
after exhausting all the qualified minority candidates and I am not eligible for fee
reimbursement scheme.

Signature of the candidate


Place :
Date :

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