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All Fields marks
*
are compulsory.
COURSE APPLIED FOR :
- Select -
B.C.A.
B.Sc.(IT)
B.Com. (CA)
B.B.A.
M.C.M.
P.G.D.C.C.A.
Part :
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I
II
III
STUDENT’S DETAILS :
Name of Student
*
:
Gender
*
:
Male
Female
Date of Birth
*
:
-Month-
January
February
March
April
May
June
July
August
September
October
November
December
-Date-
1
2
3
4
5
6
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8
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10
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31
-Year-
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
Nationality
*
:
Religion
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:
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Buddhist
Christian
Hindu
Jain
Muslim
Sikh
Parsi
Inter-Religion
Others
Caste
*
:
Permanent Address
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:
Pin No.
*
:
Local Address
:
Pin No.
:
Telephone No
:
Mobile No
:
E-Mail ID
*
:
Bank Name (Centralised Bank)
*
:
Account No.
*
:
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