Cast Category:*

(EWS/SC/ST/GEN

Student Name:*
Salutation:*
First Name

MiddleName

Last Name:

Father's Name*
First Name

MiddleName

Mother's Name *
Last Name:

First Name

Student Details
Mother's Name *
MiddleName

Guardian's Name:
Last Name:

First Name

MiddleName

Last Name:

Gender:*

Date of Birth:*

Martial Status:*

Phone with STD Code:

Mobile Number:*

Aadhaar Number(If Applicable) *

Email Address:*

Address Line:*

Permanent Address Details

Country:

State:*

District:*

City:*

Landmark:*

Correspondence Address Details

Pin Code:*

Select Yes if Correspondence

Address details same as
Permanent Address

Address Line:*

Country:

Correspondence Address Details

District:*

St

City:*

Landmark:*

Pin Code:*

Qualification Name

Student Educational / Qualification Details

University School/College

Year of Passing

Percentage

Bank Name:*

Student Account Details

Branch Name:*

Account No:*

IFSC Code:*

Beneficiary Name:*

Branch Code:

Other Inform

MICR Code:

Address:*

Attached the
Attached the Photograph
Signature(JPG, JPEG, GIF,
(JPG, JPEG, GIF, PNG image
PNG image with size up
with size up to 50 KB)):*
to 50 KB):*

Other Information
Attached the Scanned
Fingerprint(JPG, JPEG,
GIF, PNG image with size
up to 50 KB):

Attached the copy of

Eligibilty Certificate(PDF
file with size up to 400
KB):*

Attached the Cast

Attached the INCOME
Certificate:(PDF file Certificate:(PDF file with
with size up to 100 KB) size up to 100 KB) (FOR
(FOR SC & ST):*
EWS):*