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StudentID Registratio Salutation First Name Middle Na Last Name Date of Bir Gender

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Do you have
Full time W Category

Marital Sta Do you want

Highest QuaEducation Qualifying

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Aggregate Tenth Mark Twelfth MarUniversity institutes

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Present AddPresent AddPresent Add

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Present Cit Present StaPresent Pi STDCode

Phone NumMobile NumPrimary Ema

Alternate

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Permanent Permanent Permanent Permanent Permanent Permanent Test City

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How did yo

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If Newspap Which otherAre you undFrom whereFrom which Choice

c
of

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Blood Grou Citizenship

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If Others P X Board/UniX Year of P X % Of Mar X Class/Div XII Board/U XII InstituteXII Stream

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XII Year of XII % Of MaXII Class/Di UG Board/UUG Institut UG Stream UG Class / UG Program

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UG Have yoUG Board/UUG Institut UG Stream UG Class / UG ProgramUG Have yoUG Board/U

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UG Institut UG Stream UG Class / UG ProgramUG Have yoPG Board/Un

PG Institut PG Stream1

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PG Class / PG ProgramPG Have yoPG Board/Un

PG Institut PG Stream2PG Class / PG Program

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PG Have yoPG Board/Un

PG Institut PG Stream3PG Class / PG ProgramPG Have yoFather Nam

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Mother Na Father Occ Father Tel Father MobiFather EmaiExperience Designatio To Date1

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Job Descrip Experience Designatio To Date2

Job Descrip Experience Designatio To Date3

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Job Descrip Amount

Payment DaPayment M DD NumberBank drawnDD Date

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CCNumber

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CCNumber

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