Product Form APPLICATION Form(2017-2018) Name: 1 Course Applied for Name of the Course: Code: Date of Birth : Age: Nationality : Religion: Community: OC BC OBC MBC ST SC Phy. Challenged: Yes No Gender: Male Female Area: Rural Urban Father’s Name : Mother’s Name: Occupation of Father : Annual Income Rs. : Res. Phone No. : Mobile No. : Email ID. : 2. Addres (a) Permanent Residential Address (do not write your name; write only address) : PIN code : State : 3. Education Qualifications (Enclose attested copies of certificates) Board Exam Register No : (a)Name of the School/ College : Mark in Percentage (%) Examination : University / Boar : English Board: Physics Marks : Chemistry Marks : PCM Aggregate : PCM AIEEE/IIT JEES Score : (b)For Lateral Entry: Branch of Study: Pre: Final: Total: (c)For BBM Applicants only Name of the School / College : Examination: University / Board: English: Percentage: (d) For GME / ETO / MEEO/ Post Diploma Courses/ MBA / M.Sc., & M. Tech., Applicants only College: Univesity: Year of passing: Percentage / CGPA State your Main subject in your UG Course (In Capital Letters) CGPA : Cumulative Grade Point Average For GME Course only English Marks (%) : XII / Diploma Degree: (e) For MBA Students only Name of the Test CAT / MAT / ATMA / XAT / JMET / TANCET: Univesity: Year of passing:
