Reg

n
. No. _________
(Leave Blank)
NOTE: FILL ALL THE ENTRIES IN CAPITAL (BOLD) LETTERS
BASIC INFORMATION
Name Of
Candidate:
(In English) (Suname) (!ist Name)
("iddle Name)

!athe#s Name:
(Suname) (!ist Name) ("iddle Name)

"othe#s Name:
(Suname) (!ist Name) ("iddle Name)
$ate of Bith:
$$ "" %%%
Conta&t $etails:
'ddess !o Communi&ation:
!athe#s Conta&t Num(e:
Candidate#s Conta&t Num(e:
Othes (Not "andato)):
EDUCATIONAL INFORMATION
Class in *hi&h stud)ing: _____________________
+e&entage in ,evious &lass: __________________
Boad of edu&ation -+lease ti&k () in the &oe&t (o./:
CBSE
RBSE
Othes _________________
(S,e&if))
Couses0 in *hi&h seeking &oa&hing -+lease ti&k () in the &oe&t (o./:
English

"athemati&s

S&ien&e 'll
1111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111
FOR OFFICE USE ONLY
2 2
3 4 5
3 4 5
3 4 5
Registation No.: ______________________________
Class in *hi&h stud)ing: _________________________
Bat&h: ________________________________________
+a)ment Citeia -+lease ti&k () in the &oe&t (o./:
+atiall) Cumulative