Application for Lateral Entry 2019-20
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Fields marked with* are mandatory.

 
Course Preference
 
*Programme First Preference
Second Preference Third Preference

Personal Details
*Salutation
*Full Name

Please enter your Full name as per your qualifying examination certificate. Do not
 repeat the salutation. Leave one space before initials Ex: Abdur Rahman. B. S
*Gender *Date of Birth(DD/MM/YYYY)
*Religion *Community
*Mother Tongue
Aadhaar Card Number

Parents Details
 
*Name of the Father *Occupation of Father
Father's Mobile Number
*Name of the Mother *Occupation of Mother
Mother's Mobile Number


Address For Communication
*Address Line 1 *Address Line 2
Address Line 3 *Country
*State
*City
*Pincode Phone No (with STD code)
*Mobile No *Email ID

 

Qualification Details
 
*Branch of Study in Diploma Register No.
*Medium of Instruction
*Year and Month of Passing/Appearing
*Name & Address of the institution

Marks Obtained in the Qualifying Examination

*Percentage of Marks obtained in Diploma

Upload Photo
 
*Please Upload your Photo Upload here  
 
Payment Details
*Payment Mode
I would like to contribute Rs.50/- for the education of unprivileged students
Total Amount (in Rupees) /-


Declaration
 

I hereby certify that the information given by me in this Application Form is true to the best of my knowledge.

 
    I Agree
Version 13.06.01