Fulfilled by the applicant

Name of Subject *

Applicant's Name*

Gender : *

Fathe's Name *

Mother's Name *

Date of Birth *

Bloog Group *

(Hon/Deg/Per/Bed) Roll no.: *

(Hon/Deg/Per/Bed) Reg no.: *

(Hon/Deg/Per/Bed) Passing Year: *

Marks Obtain/CGPA(Graduation level): *

Total Marks/CGPA(Graduation level): *

Contact Address *

Mobile Number*

District*

Image size is 300 KB maximum (should be JPG)*