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Course Applied for
Entrance Test Qualified  Yes No
Percentile

Full Name of the Candidate
Father's Name
Mother's Name
Date of Birth
Address
Address Line 2
Address Line 3
City
ZIP / Pin Code
Res. No
Mobile
E-mail

Examination Name of the School / College/Institution University Board/Institution Location of University/Board/ Institution Year of Passing % of Marks
10th / SSLC
12th / PUC
Graduation
Others