APPLICATION FORM
Application for admission to:
Specialization in (Compulsory):
Name in full (Block Letters):
Date of Birth:
Gender:
Whether belongs to: SC/ST/OBC/Armed Force Personnel/War Widow Kin/Kashmiri Migrant/Physically Disabled:
Nationality:
Father's/Husband's Name:
Mother's Name:
Corresponding Address:
Permanent Address:
Contact number with
STD/ISD Code: (O):
(R):
(M):
E.Mail id:
Educational Details:
(Start from 10th till last attained/attaining):
Year Certification Institution Subjects Result
Working: If yes? details starting from recent to go back:
Any other detail/s deemed fit to consider for admission:
Exam Option: from Home
at Centre
Online
Course fee details:
DECLARATION: I certify that all the information provided on this application form is correct and complete to the best of my knowledge. I agree to abide all the existing / to be introduced rules and regulations of the institution. That fee once paid is not refundable / adjustable/ transferred in any case. I have understood the course details and requisite formalities. Any information given, if found false, the institution reserve the right to cancel my admission / certification.
Signature of the Applicant
Date:
Place:
NOTE::::::::
1) Where necessary use extra sheet to submit the details.
2) Use only black gel pen while filing the application form
3) The applicant should complete the form neatly in his/her own handwriting
4) Four passport size photograph to be attached with application form.
5) Attested copies (from Government Officer/s) of the proof of information given be attached (educational/caste/work/residence, etc.):
6) For one course, one application form is required. The fee once paid will not be refunded / adjusted / transferred. Students are advised to obtain proper receipt of the fee paid for records.
FOR OFFICE USE::::::::::::::::::::::::::::
The documents have been verified and fee to the course received vide Receipt No._________________.
Balance amount if any____________________.
Signature of Counselor
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