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112018100159
112018100159
1. NAME :
2. FATHER’S NAME :
3. PERMANENT ADDRESS :
4. CONTACT NO :
5. EMAIL ID :
6. DATE OF BIRTH :
7. GENDER :
8. NATIONALITY :
9. RELIGION :
10. CASTE :
11. MARITAL STATUS :
12. LANGUAGE KNOWN :
13. EDUCATIONAL QUALIFICATION:
NAME OF BOARD YEAR OF % OF DIVISION
EXAMINATION PASSING MARKS
Semester-1
Semester-2
Semester-3
Semester-4
W.B.S.C.T.E
Semester-5
Semester-6 APPEARING
Declaration
I do here by declare that the above statements are true and correct to the best of my knowledge and belief.
Date :-
Place :- Signature