| Name* : | 1st name: | 2nd name: | 3rd name: |
| Date of birth *: | |||
| Permanent Address*: | City: | Pin code: | District |
| Alternate Address* : | City: | Pin code: | District |
| Your contacts* : | Father's contacts* : | ||
| Father's Occupation* : | Mother's Occupation* : | ||
| Father's Income* : | Mother's Income* : | ||
| Gender* : | Mail: | Femail: | Other: |
| Your Qualifications* : | 10th | 12th | Graguated |
| your cast *: |