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Name of the applicant (As in School Record) *

Date of birth * - Date - 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 - Month - January Febuary March April May June July August September October November December - Year - 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Email Id *

Mobile *

Caste, Religion and denomination *

Name of Sub Denomination if any

Address to which communications are to be sent
(with district & PIN code) *

Name and Address of School/College last studied *

Upload Your Passport Size Photo* (Image of width 150 pixel and Height 200 pixels and size below 50 KB.)

Upload Your Signature* (Image of width 140 pixel and Height 60 pixels and size below 20 KB.)

Upload Your Parent Signature* (Image of width 140 pixel and Height 60 pixels and size below 20 KB.)

Gender *  Male   Female

 

Nationality

State *

Name of Church/Insitution

Diocese

Pincode *