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Name of the Candidate *

Father's Name *

Mother's Name *

Gender *

Male

Female

Religion *

Hindu

Christian

Muslim

Community *

Date of Birth *

Age *

Door No *

Street Name *

City Name *

Pincode *

Contact Number *

Whatsapp Number *

Course Studied *

Name of the School *

+1 Mark *

+2 Mark *

Total Marks *

1 st Choice *

2 nd Choice *

3 rd Choice *

For Girls, Hostel Facility

Yes

No

Last Name

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