Academics Name * :
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Course Name* :
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Membership No * :
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Personal Information
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Student Name * :
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Father's Name * :
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Mother's Name * :
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Date of Birth :
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Nationality :
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Sex :
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Religion * :
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Category * :
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Complete Address *:
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State :
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Dist :
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Pin No * :
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Contacat No (with STD) :
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Mobile No * :
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Educational Information
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Declaration : I acknowledge to have fully read the prospectus and certify that i have understood all the provision indicated there in I certify that i am qualified for the program as indicated in the prospectus. I understand that my admission is liable to be cancelled if i suppress or distort any information famished in my application. I understand fee once paid will not be refunded. I will maintain all the rules & regulation of this institute.'
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