PREREQUISITES FOR STUDENTS FRESH APPLICATION FORM

SSC or equivalent Id. Scanned Passport Photo of size less than 100KB (Not Applicable for Board of Intermediate 1st year Students). Email ID. Mobile No. Caste Certificate. Income Certificate. Bank Pass Book (For EBC not Required). Allotment Order (for CET Courses)
Have you applied in ePASS in 2010-11? - yes /no if yes Enter Application ID(2010-11):

Passport Size Photo

STUDENT SSC DETAILS SSC Pass Type: AP Regular/AP Supplementary/Other Board/CBSE/ICSE SSC Hall Ticket No: SSC Pass Year:

Student Name : Father / Mother Name : Date Of Birth : Student Bank Account No : PRESENT COLLEGE DETAILS College District : University / Board : Present Course Name : College Mandal : Present College Name : Present Course Year :

FRESH APPLICATION FORM FOR 2011-12 Applicant Details Registration: Ration Card No. if available: UID (Aadhar) No. if available: Religion: Date of Birth: Caste Category: SC/ST/BCSub Caste : NCC : Yes / No Profession of Parents/Spouse : Family Annual Income(Rs) : Gender : Disabled Category : Yes / No /OC/EBC (Listed)/EBC (others)

STUDENT PRE - QUALIFICATION (PREVIOUS EXAM) DETAILS Qualifying Class : Marks Obtained : Total Marks :

INSTITUTION DETAILS College Admission No : College joining Date(Current Year) : Hostel joining Date(Current Year):

Distance between College and Native Place (Kms) : Schloarship Type :

STUDENT BANK ACCOUNT DETAILS Bank District : Bank Name : Bank Branch Name & Code : Student Bank Account No *

ADDRESS FOR COMMUNICATION District : Mandal : Village : Door No / Road No / Location : Pincode : Mobile No : E - mail Id : Mobile No. Belongs to :

HANUMAN XEROX & INTERNET M.R.PALLI CIRCLE, TIRUPATI. PH: 0877-2245578