All (*) marked fields are mandatory

Admission is Sought for * --------- NRI Seat Managment Seat

Name *

Permanent Address *

Pin Code *

Communication Address *

Pin Code *

Phone number *

E-mail*

Date of Birth *

Age *

Gender * --------- Male Female Other

Religion *

Cast *

Name of Parent *

Occupation *

Mobile No Of Guardian *

Nationality *

Annual Income *

Are You Physically Handicapped? *

--------- Yes No

Applicant Photo *

Select 132 X 170 Pixel JPG Images Only

Upload Signature *

Select 130 X 60 Pixel JPG Images Only and Upload White background image

Details of Qualifying Examination

Register Number *

Year of Passing *

No. of Appearance *

School/Colleges *

Board/University *

Total Marks in Plus two examination

Mark Obtained	Total Score
	1200

Subject Wise Mark of 10 +2/Equivalent Examination

Subject	Marks Obtained	Maximum Marks
Physics *		120
Chemistry *		120
Biology *		120
Total	0	360
English *		200

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