BOARD OF INTERMEDIATE EDUCATION:AP

(Application Form for Two Years Intermediate Course)

Academic Year: 2021 to 2022 PASTE RECENT
COLOUR PHOTO

COURSE: NPL / NEON - AC / NEON - NON-AC

ADMISSION NUMBER:
Student Signature
1. Xth Class H.T.No: ____________________
2. Student Aadhaar No: ____________________________
3. Group in which Admitted: MPC / BIPC
4. Second Language in Intermediate (Part II): SANSKRIT
5. Candidate’s Name: _________________________________________________________________
(AS PER 10TH MARKS SHEET)

6. Date of Birth: (DD/MM/YYYY)

7. Father’s Name:

8. Occupation:

9. Mother’s Name:

10. Occupation:

11. Nationality: 12. Religion:

12. Mother Tongue: 14. Sex : Male Female

13. Community: 16. Sub-Caste :

14. Mee-seva Caste Certificate Number (Compulsory)

(EWS,BC-A, BC-B, BC-C, BC-D, BC-E, SC, ST castes only)
15 Mee-seva Income Certificate Number : (Not Compulsory)
(BC-A, BC-B, BC-C, BC-D, BC-E, SC, ST castes only)

(FOR PREVIOUS AMMAVODI ELIGIBLE STUDENTS ONLY)

16. (a) Mother Bank Account Number: IFSC Code:

Bank Name: Bank Branch:

Mother Aadhaar No: Mother Phone No:

Sachivalayam Code No & Place:

 (b) New Rice Card Number:

17. Physically handicapped: Yes No 22. 22. CAP/NCC/Sports/Games: Yes No

18. Identification Marks 1. 1.

(AS PER 10TH TC)
2.
2.

19. Name of the Last Studied Institution (10TH):

20. Receiving any Scholarship: Yes: No:

21. Student Address

House / Flat No Street.

Village. Mandal.

District. State.

Postal Pin Code. Habitation Code / Ward Number.

22. Parent Mobile Numbers: 1. 2.

23. Student E-Mail Id:

24. SSC / CBSE / ICSE / Other Board/ Grade Points / Marks: /

DECLARATION
I abide by the rules and regulations of the college and Board of Intermediate Education. I affirm that the
information formatted in the application form and enclosures submitted are true and correct. I do not act against
the rules and regulations and my behavior and conduct do not go against the college.

Signature of the Candidate Signature of the Parent Signature of the Principal

ENCLOSERS: 1) ORIGINAL TC (2) SSC MARK LIST XEROX (3) LAST STUDY XEROX

(4) STUDENT AADHAAR CARD XEROX (5) CASTE CERTIFICATE XEROX (FOR SC, ST, BC AND EWS)

(6) MOTHER AADHAAR CARD AND MOTHER BANK PASS BOOK XEROX ( FOR AMMAVODI APPLY STUDENTS)

(7) STUDENT LATEST PASSPORT COLOUR PHOTOS