Name of applicant

Surname

(in Capital Letters) Mr./Ku./Mrs.

Caste

D.O.B (required)

Sex

Category

Father's Name

Husband Name

Mother's Name

Medium

Occupation

(Last University Attended

Last Exam. Passed with Year

Graduation's Subject (required)

Post Graduation's Subject

Current Address

Mobile No. / Landline

Permanent Address

E-mail Id

Aadhar No.