1. Name of the Candidate: 2. Father's Name: 3. Father's Occupation: 4. Mother's Name: 5. Mother's Occupation: 6. Age (Candidate): 7. Date of Birth: 8. Postal Address with Pincode: 9. Phone No: 10. Mobile No: 11. Parmanent Address: 12. Nationality: 13. Religion: 14. Cast (Tick Mark): SCSTOBCGEN 15. Academic Record: Name of Examination Year of Passing Board/Council/University Stream Full Marks Marks obtains % of Marks Madhamik or its equivalent H.S.(10+2) or its equivalent Graduation ( Attached Copy of all the mark sheets, admit & pass Cartificates of academic records must be submitted along with the Application Form) 16. Upload Photo: Signature not required
