Application Form

First Name * :

Middle Name :

Surname * :

Address for Correspondence * :

Pin * :

Phone Number :

Mobile Number * :

E-Mail ID * :

Guardian's Name :

Date of Birth * :

Status of 10+2 Examination for Bachelor Degree*

Status of 10th examination for Diploma *

Declaration :
I hereby declare that the particulars furnished above are true and correct to the best of my knowledge and belief. I have carefully gone through and understood the conditions of admission as published in the admission notice.

State of Domicile :
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Place * :