5.

IN S TR U C TIO N S FO R FILLIN G TH E FO R M

PLE AS E FO LLO W TH E SIM P LE STEPS W H ILE FILLIN G THE FO R M S

1. Use the B LACK B AL L PEN to fill the details and to sign the form .
2. Do not put any stray m arks on Black Squares and Barcode.
3. Fill com plete circles for the selected options else leave it blank if not applicable as shown in the exam ple:

4. W rite clearly within the boxes, as indicated in the following exam ple:

5. Do not over write.

6. Please write the date in DD-M M -YYYY form at.
7. Do not bend/fold the form .
8. Please refer the table below for State Codes.

S T ATE /U T C O D E S T AT E /U T N AM E S T ATE /U T C O D E S T AT E /U T N AM E
AN ANDAMAN AND NICOBA R LK LAKS HADEEP
AP ANDHRA PRADES H MP MADHYA PRADESH
AR ARUNACHAL PRADES H MH MAHARAS HTRA
AS ASSAM MN MANIPUR
BH BIHA R MG MEGHALAYA
CH CHANDIG ARH MZ MIZORAM
CG CHHATISGARH NG NAGALAND
DN DADRA AND NAGA R HAVE LI OR ORISSA
DD DAMAN & DIU PN PONDICHERRY
ND DELHI PB PUNJA B
GA GOA RJ RAJAS THAN
GJ GUJARAT SK SIKKIM
HR HARYANA TN TAMIL NADU
HP HIMACHAL PRADES H TR TRIPURA
JK JA MMU & KAS HMIR UP UTTAR PRADESH
JH JHARKHAND UT UTTARAKHAND/UTTRANCHAL
KR KA RNATAKA WB W ES T BE NGAL
KL KE RALA