1.

Name cofthe
candidato
BIO-DATA
.
2. Date of
birth
3. Religion and Nationality
Photo of the
4. Name ofthe
coummunity candidate
S. WaMther BCMBCSCSTIOCBCM/SCA/BCM

6. R esidential address and

Telephone No.
Mobile No.
E-meil id
7. Pureut Oordie's Neme &Oocupaaon
8 ncome
9. Ofice ddreas and TelAMobile No
1.0. Ne ofthe School stuadicd
Colleg&Uaiversily (for PG Applic)
13.Tick he agproprinte HSCICBSE/OTHER BOARDNRI
12. Tik ifapplicable
:Difeready abled/Ex-Service mom/Sports/NCCNSS
1.Persoaal Tdentifsication mauiks )
(2
14. Vehice Neme, No. smd
Licence No.
oelratdon
g e to fut the atendance reqairemataperthe eniverlty mores and to pay he Ter fs en or bee e the dee date

Sigure of the Snden S b u r e e Pareat

(Ror offics ue only)

1. Applicadon No.

2. Course Aduaittod

3. Thate of Admon
4. Langa

5. Certiice courves preferred/hdiraited

6. Admission no.