Full Name in Block Letters

Name of the Father/Guardian

Date of Birth & Age

Nationality & Religion

Details of Caste :
(SC/ST/BC - enclose certificate)

Mother Tongue

Father's/Guardians :
(a) Occupation :
(b) Annual Income (enclose certificate) :

Details of previous education :
( enclose SSC / Equivalent certificate)

Whether vaccinated

Nature of Blindness

Marks of personal identification : (a)

                                                  (b)

. Address
a. Permanent with Telephone Number

b. Local with Telephone Number