1. PERSONAL DATA :
*
NAME OF THE CANDIDATE : Last
First
Middle
* PERMANENT
MAILING ADDRESS: C/O :
City
:
State :
Postal Code :
Country :
Telephone:
- -
(Country code - Std code -
Phone Number)
Email_id :
* DATE
OF BIRTH : Day :
Month :
Year :
* GENDER
:
Male
Female
* MARITAL STATUS : Married
Unmarried
*
COUNTRY OF CITIZENSHIP :
* OMAT/MAT/ATMA
ROLL NO
: RANKMONTH
& YEAR
* HOSTEL
ACCOMODATION :Yes No
11. EDUCATION
List
of Board/College/Universities you have attended , starting with the most
recent.
I certify that to the best of my knowledge the information's provided in
this application is accurate and complete . I understand that if this information
or any other information upon which my admission is based is found to be
inaccurate or incomplete , the institute may rescind my degree .If admitted,
I agree to abide by the rules and regulations of the institute including
, but not limited to those contained in the current institute web site.
Applicant's Name :
|
