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Registration No

Your name

Date of Birth:

Nationality & Religion:

Community
---OC Anglo-IndianSC/STBC,MBCOC-Others,BCM

Father's Name:

Father's Occupation:

Father's Annual Income

Mother's Name:

Mother's Occupation:

Mother's Annual Income

Guardian's Name:

Relationship:

Guardian's Occupation:

Guardian's Income:

Marital Status:
---SingleMarriedOthers

If Married No. of Children:

Husband's Name:

Husband's Occupation:

Husband's income:

Address for Communication :

Name of the District/City:

Pin Code:

Mobile No:

Alternate Phone:

WhatsApp No:

Permanent Address:

Name of the City/District:

Pin code:

Marks secured in X standard :

Board of Examination :
---State BoardCBSEOthers

Marks secured in XII Standard:

Group Taken in XII :
---ScienceArtsVocational

Medium of Instruction from I Std to X Std:

Medium of Instruction Standard XI and XII:

Language taken under Part I:
---TamilFrenchHindiSanskrit

Mother Tongue:

Please attach the scanned passport size photo

Please attach the scanned photo of the Candidate's signature

Please attach the scanned copy of 12th Mark sheet

I hereby declare that all the information provided by me are correct and true to the best of my knowledge. Any correction in the uploaded form will be my sole responsibility

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