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Name

Date of Birth

Gender

Nationality

Religion

Aadhaar Number

Family Details

Father's Name

Father's Mobile Number

Father's Occupation

Mother's Name

Mother's Mobile Number

Mother's Occupation

Guardian
(if both Father & Mother not alive)

Local Guardian If Any
(for Non-Bangalore Candidate only, Parents approval is a must)

Postal Address

Permanent Address

Signature & Address with Phone No.

Educational Qualification

NUMBER OF FULL ACADEMIC YEARS STUDIED IN KARNATAKA
BETWEEN 1 STD AND QUALIFYING EXAMINATION: (Write 6 years) as 06

S.S.L.C. OR EQUIVALENT EXAMINATION PASSED (If Karnataka SSLC write 1, if equivalent exam in Karnataka write 2, other write 3)

YEAR OF PASSING S.S.L.C. OR EQUIVALENT EXAMINATION:
(A for Annual, S for Supplementary)

A

S

TOTAL MARKS SECURED IN SCIENCE:

OUT OF

TOTAL MARKS SECURED IN MATHS:

OUT OF

TOTAL MAXIMUM MARKS SECURED IN ALL SUBJECTS:

OUT OF

MEDIUM OF INSTRUCTION IN QUALIFYING EXAMINATION:

Education

PARTICULARS OF SCHOOL/COLLEGE WHERE THE CANDIDATE STUDIED DURING LAST 5 YEARS
STANDARD	YEAR	NAME OF THE INSTITUTION	DISTRICT	STATE





EXTRA CURRICULAR ACTIVITIES			OTHERS

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MARKS CARDS OF QUALIFYING EXAMINATION

TRANSFER / LEAVING CERTIFICATE

MIGRATION CERTIFICATE

ELIGIBILITY CERTIFICATE

MINIMUM 5 YEARS STUDY CERTIFICATE FROM 1ST STANDARD TO QUALIFYING EXΑΜΙΝΑΤΙΟΝ
[FOR KARNATAKA CANDIDATES ONLY Counter Signed by Block Educational Officer (Β.Ε.Ο.)]

CHARACTER & CONDUCT CERTIFICATE

STAMP SIZE PHOTOS - Nos.

MEDICAL CERTIFICATE

OTHER CERTIFICATE IF ANY

FOR FOREIGN NATIONALS GOVT. OF INDIAN PERMISSION

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Education

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