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Personal Details
Name * : Gender * :
Date of Birth * : Blood Group :
Category * : Nationality * :
Program * :
B.Tech Preferences
Preference 1 * :
Preference 2 :
Preference 3 :
Upload Photo(Only .jpg or .jpeg or .gif formats, Upto 100 kb)
Upload Photo :
Present Address
Address Line 1 * : Address Line 2 :
Address Line 3 : City * :
State * : Country * :
Pincode * : Tel.:(Residence)(with STD/ISD code) * :
Mobile Number * : Fax :
Primary Email * : Retype Primary Email * :
Alternate Email : Retype Alternate Email :
Is Permanent address same as Present ? * :
Family Details
Father Name * : Mother's Name * :
Qualification : Mother's Qualification :
Occupation : Mother's Occupation :
Organization : Mother's Organization :
Address * : Mobile Number :
Parents Email ID : Telephone-Office(With STD Code) :
Telephone-Residence(With STD Code) * :

 
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