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NAME OF CANDIDATE(CAPITAL LETTERS)

Gender(tick Mark) Male Female

DATE OF BIRTH(DD/MM/YYYY)
PERMANENT ADDRES IN SSLC
CERTIFICATE/RATION CARD/NATIVITY
CERTIFICATE
PIN CODE
PHONE NUMBER (Used in Application)
PHONE NUMBER (Optional)
Name of Father

Name of Mother

Name of Guardian

email ID
DISTRICT IN SSLC CERTIFICATE/RATION
CARD/NATIVITY CERTIFICATE
TALUK IN SSLC CERTIFICATE/RATION
CARD/NATIVITY CERTIFICATE
LOCAL BODY IN SSLC CERTIFICATE/RATION
CARD/NATIVITY CERTIFICATE
Caste,Category, Religion, Caste IN SSLC
CERTIFICATE/CASTE CERTIFICATE
Community Category (ACTUAL hsCAP ENTRY)
Whether Belongs to OEC? (hsCAP Entry) – Yes/No
AADHAR NUMBER
Type of Disability (OH/Blind/Deaf/Mental) and
Certificate Number
Annual Income (for EWS Candidates)

Grade Lan1 Lan2 Eng Hin SS Phy Che Bio Maths IT

SSLC

OTHER
OPTIONS

Option School Name of School Course


No Code Code

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