-_ Sins Sie (Ministry orn. gon ovement a India Society) Elankand =f 108 Sl roksan Fart emcee PS eens Hi TRG! f fi > |For Office Use Only Reg. No. Course Applied for Course Commencing date Timing Name of the Applicant : : (in Capital letters) = Father's Name (in Capital letters) Father's Occupation : : ‘Date of Birth (DD/MMIYYYY) aa eek L aot Category (SC/STIOBCIGEN) —: ae Csr joscLisen Coen oe Sex(MIF)* : ——— aMinorty [5 SH... thers ayaa Phone/Mobile No. 2 2 7 be Photograph E-mail ID : “ Whether Sponsored (vesiNo) Name of the Sponsoring Authority : (if Sponsored) Whether required hostel (Yes/No) : How did you come to know about this course : Postal Address (In Capitals) Bank Account No. IFSC Code No. ‘Aadhar Card No. CORRESPONDENCE ADDRESS, PERMANENT ADDRESS: PIN. PIN: Educational Qualification/Other Prensa Qualification/Training Courses etc. : Si. | Exam Passed | Year of | Duration of the Board? % age Branch? No. Passing | Degree/Diploma | University | of Marks | Specialization — Experience (if any) : Declaration : | do hereby declare that the above information are true & | shall abide by the rules & regulations of the Institute. Date .. Place: Note : Please attach a copy of caste certificate and Aadhar Gard in case of SC/ST. Signature of Admission (UC) Signature of Candidate