1. Name of the Applicant :
(in BLOCK letter only)
2. Name of Father/Mother/Husband :
3. Date of Birth :
4. Nationality :
5. State of Domicile :
6. GU Registration:
  of    AF:   
Permanent Address C/O:

Vill/Town:

PO:

PS:

District:

State:

Pin Code:
Correspondance Address C/O:

Vill/Town:

PO:

PS:

District:

State:

Pin Code:

If Correspondance and Permanent address are same Click here

Mobile No. : Email:
Prefered Examination center:
Contact center: Study Center:
Category SC ST OBC MOBC GeneralSex: Male Female
Academic Records (Only Qualifyning Examination) Examintion Passed:

University:

Subject Offered(Please separate by Coma):

Year of passing:
Extra Academic Records (For MCA Lateral applicant only) Examintion Passed: (like PGDCA,DOACC A)

University:

Year of passing: