Name Of Student

Father’s Name

Mother’s Name

Address

District

State

Pin Code

Mobile No.

Student’s Email ID

Gender
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Date of Application

Course Name

DECLARATION BY STUDENT: I here by declare that I have provided necessary information required in this form in the event of any information being found misleading, my admission shall be liable to cancellation by the institute at any time and shall not be entitled to refund fee by me in the institute……..

Student’s Photo

Signature