Applicant's Name *

Father's Name *

Mother's Name *

Date of Birth *

Class *

School / Coaching / Library Name *

Gender * Select Gender Male Female Other

Marital Status * -- Select Marital Status -- Unmarried Married Other

Religion * -- Select Religion -- Hindu Muslim Sikh Christian Buddhist Jain Other

Category * -- Select Category -- SC ST OBC General Minority

Permanent Address *

Temporary Address *     Same as Present address

Mobile Number *

Email ID

Passport Size Photograph *

Applicant's Signature *

Declaration: I declare that the above information given by me is absolutely true and correct. If the information given by me is found to be incorrect at any stage then my application should be cancelled, on which I will not have any objection.