| Name of the Candidate |
|
| Gender |
Male
Female
Transgender
|
| DOB (As per SSLC Certificate) |
|
| Community |
|
| Differentially Abled / Destitute Widow |
|
| Father's Name / Guardian's Name |
|
| Mother's Name |
|
| Address for Communication |
|
| Mobile No |
|
| Email ID |
|
| DD No |
|
| DD Date |
|
| DD Amount |
|
| DD Bank & Branch |
|
| Candidate's Photo |
|
| Candidate's Signature |
|
|
|
|
|
|
