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Adobe Scan 10 Aug 2023
Adobe Scan 10 Aug 2023
Adm. No.
----- Date of Admission _ _ _ __
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{ IN CAPITAL LEffiRS ONLY leave space wherever required) (As per records) (Attach Proof)
2) MOTHER'S NAME
---------------( in running hand)
IIIIIIIIIIIIIIIIIIIIIIl
( IN CAPITAL LETTERS ONLY leave space wherever required) (As per records) (Attach Copy of Adhaar Ca
rd
)
3) FATHER'S NAME
- - - - - - - - - - - - -( in running hand)
IIIIIIIIIIIIIIIIIIIIIII
( IN CAPITAL LETTERS ONLY leave space wherever required) (As per records) (Attach Copy of Adhaar Ca
rd
)
I l l- l I !,_7-J IIII
st
Age as on 31 March 2021·- - - - - - - - - -
5) Category
Isc j I ST / I I I I
OBC GEN
(Attach Proof)
I I I I 1~~-1 I I I 1\8 I I I I
7) Single Child :-Yes/No _ _ __
8) Email ID _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
11) Subject- Fill the selected subject along with subject code in the box
I hereby certify that information given above is correct and as per records .