PASTE YOUR

PHOTO APPLICATION FOR +1 HIGHER SECONDARY COURSE

(Use same ) PERSONAL INFORMATION

(USE BLOCK LETTERS ONLY)

1. Name :

2. Gender :

3. Permanent Address with Pin code :

4. District :

5. Taluk :

6. Block :

7. Date of Birth :

8. Religion :

9. Caste :

10. Category :
(General/OBC/OEC/SC/ST)
:
11. Nationality
:
12. Name of Guardian
:
13. Relationship
:
14. Register Number 10th standard Passed
:
Month
:
Passed Year

15. Board Name

(CBSE/ICSE/SSLC/THSLC/OTHERS) :

16. Aadhar Number

:
17. TC.No. and Year

(Transfer certificate obtained from the

School last studied)

18. Communication Address :
Pincode :
District :
19. Mobile Number of Father (Whatsapp) :

Mobile Number of Mother (Whatsapp) :

Student Number (Whatsapp) :

20. Name of Account Holder :

Account Number (Student/Guardian) :

IFSC Code :

Bank Name :

Bank Branch :

District :

21. E-mail ID :

22. Whether the applicant is differently abled :

23. Group

Science stream – Mention it

• Physics/Chemistry/Biology/Mathematics :

• Physics/Chemistry/Biology/Psychology

• Physics/Chemistry/Computer/Mathematics :

24. Second Language (Hindi / Malayalam / German) Specify :