Personal Details
Full Name(as per the transcript of X std) *	:		Gender *	:	MaleFemale
Date of Birth *	:	[DD] 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 [MMM] Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec [YYYY] 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000	Category *	:	--Select-- SC ST OTHERS
Program *	:	--Select-- MBA EPGDM	Session *	:	--Select--
Nationality *	:	--Select-- Indian NRI Foreign National	Blood Group *	:	--Select-- A +ve A -ve AB +ve AB -ve B +ve B -ve O +ve O -ve Others

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Present Address
Address Line 1 *	:		Address Line 2	:		Address Line 3	:

City *	:		State *	:	--Select-- Andaman & Nicobar Islands Andhra Pradesh Arunachal Pradesh Assam Bihar Chandigarh * Chhattisgarh Dadra & Nagar Haveli Daman & Diu * Delhi * Goa Gujarat Haryana Himachal Pradesh Jammu & Kashmir Jharkhand Karnataka Kerala Lakshadweep * Madhya Pradesh Maharashtra Manipur Meghalaya Mizoram Nagaland Orissa Pondicherry * Punjab Rajasthan Sikkim Tamilnadu Tripura Uttar Pradesh Uttaranchal West Bengal Others
Country *	:		Pincode *	:
Phone Number (With STD Code) *	:		Mobile Number *	:
Fax	:		Primary Email *	:
Retype Primary Email *	:		Alternate Email	:
Retype Alternate Email	:		Is Permanent address same as Present ? *	:	YesNo

Family Details
Parent / Guardian's Name *	:		Relationship with the applicant *	:
Qualification	:		Occupation	:	--Select-- Service Own Business Professional Others
If Others Please Specify	:		Designation	:
Organisation	:		Address *	:
Telephone-Office(With STD Code)	:		Telephone-Residence(With STD Code) *	:
Fax (With STD Code)	:		Email	: