Diploma

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Name:
Date of Birth:
Sex:
Place of Birth:
State/Country:
Nationality:
Religion:
Mother Tongue:
Father's name:
Father's Occupation:
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Postal Address:
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Telephone No.
Fax No.

Educational Qualifications:

Std.	Name of Institute	Passing Year	Exam. Authority	%Obtained
X
XII or equivalent
Higher (if any)

Select the course you'd like to pursue:

Accommodation in hostel required?