Address Details

Postal Address

City

State

Country

Pin Code

DECLARATION BY THE APPLICANT *

I do hereby declare that the information furnished above is true to the best of my Knowledge.In case, any of the above information is found to be incorrect or false at any stage, my admission will automatically atand cancelled and shall be liable for penal action. I also agree to abide by the rules and regulations pertaining to anti-ragging measures specified in the prospectus failing which disciplinary/ penal action may be taken against me.

Date

Form No :

( Photograph of the Applicant )

( size Less than 400 kb)

High School Examination Passed

Intermediate Examination Appearing / Passed