Narne of tre guardian and relatonqhip (if father/mother. is nol alive) 5

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Narne of tre guardian and relatonqhip (if father/mother. is nol alive) 5
ii:.i:'5: i
'
Narne of tre guardian and relatonqhip
(if father/mother. is nol alive)
5.
Permanent address of the
6.
Religionand Caste
7.
fdrer
or
sudrdia!
.,
,
., ;
r..
Whether you belong to Scheduled Castel
Scheduled Tribe/tsackuaard Class
State Sect, if pu belong to anY one of
these categories
8.
9.
Annual incomd bf father/ guardian
a) Date of birth (in Christian era)
!)
Place of Birth (Here enter place, Taluk & District)
c) State of domicile
d) Mother tongue
e) Language known
Contd.............
12. Qualifying Examination Passed : pDClpUC/10+2
Sl. No.
13.
MARKSOBTAINED
SUB'ECTS
II'!QI,ALIFYINGA(AilN.
Details of enclosures to be attached to the application
PERCETTAGE
:
a) Marks Card of S.S.L.C.
b) Marks Card of P.U.C. ('lO+2) or any equalent qualiffing examination
c) Migration Certificate (if studied outside Kamataka)
d) Transfer Certificate
e) Course &.Conduct Certificate
f) Caste Certificate (if betongs to SC/ST/OBC)
g) Medical Fitness Certificate
h) 6 sets of attested Xerox copies of all original certificates
i) Latest stamp size & passport size colour photos (4 Nos. each)
agree to the condition that in case any information fumished in the application is found to be false, this
application for admission may be cancelled and the fees paid may be forfeited.
I
Date:
Place:
Signature of the Candidates
Signature of the parenUlegal guardian (if parents not alive)
certified that the reiords of the candidate have been verified and found conect
Signattire of ihe Principal
.
with Seal

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