Course	:
Application No	:
Admission No.	:
Admitted in	:
1. a.Name of the applicant	:
b.Expansion of initials	:
2.Date of Birth	:
3.Place of Birth and District	:
4.State which the applicant belongs	:
5.Nationality	:
6.Religion	:
7.Community (OC / BC / MBC / SC / ST )	:
8.Caste	:
9.Name & Address of the Parent / Guardian	:
10.Address to which communication may be sent	:
11.Phone No. / Mobile No	:
12.Occupation and Annual Income of Parent / Guardian	:
13.Are you seeking admission in any professional College	:
14.a.Examination Passed	:
Medium	:
b.Name and Address of the Hr.Sec. School Last attended	:
15.a. First Choice	:
15.a. Second Choice	:
16.Athletic Distinction (if any) NCC / NSS	:
17.Extra - Curricular Activities	:
18.Do you need Hostel Accommodation	:

19.Marks obtained in the Qualified Examination

Subject	Marks	Max. Marks	Month & Year of Passing	Register No	No. of Attempt
		100
		100
		100
		100
		100
		100
Total		600

I declare that all the particulars furnished above are true and correct. I submit that I will abide by the rules and regulation of the college.