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* marked are mandatory

Please fill the following to generate Bank Challan (Part-I of your application form)
Be careful to fill the information below correctly as this will become non-editable once you press the submit button

Name (as appearing in 10th class mark sheet)*: Father's name*: Mother's name*: Date of Birth (as appearing in 10th class mark sheet)*: Gender*: Category*: Male GEN SC ST OBC SBC Not handicapped physically PH PH with bone deformity OL & OA Unmarried Married Divorcee Widow Widower Yes No Present communication address Address*: Female

Sub-category*:

Marital status*:

Knowledge of Hindi language in Devnagri Script (lipi)*:

City*: Pincode*: District*: State*: Contact details STD code: Phone No.: Cell No.: E-mail ID:
Important: This screen is not your application form. Do not print this screen. Your part-I of application form will be generated only after clicking on submit button appearing below
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