Name*



 
Email*

 
Phone Number*

 
Religion*

 
Gender
MaleFemale
 
Date of Birth*

 
Category*
---GMSCSTGroup IGroup II-AGroup II - BGroup III AGroup III - B
 
Physically Challenged*
YesNo
 
Language You ave studied Earlier ( in 12th Std)
*
---KannadasanskritHindiMalayalamEnglish
 
SSLC Marks (in percentage )*

 
SSLC (Year of passing )*

 
2nd PU College ( Name + board of exam )*

 
2nd PUC Marks (in percentage )*

 
2nd PUC (Year of passing )*

 
Aadhar Card number *

 
Fathers Name*

 
Fathers mobile number*

 
Mothers Name*

 
Mother mobile number*

 
Mother mobile number*

 

Current Address*

 

Passport size photo*

 ×  four  =  twenty