Iconic-aplication-form

Application Form

Please Fill This Form in ENGLISH and in BLOCK LETTERS

A. IDENTITY DETAILS

Name of the Applicant

Father’s/ Spouse Name

Gender

Marital Status

Date of Birth

Nationality

Status

PAN

Aadhaar Number (if any)

Student Photo

Your Photo Must be in Passport (PP) Size. Max Upload Size 1MB.

Specify the Proof of Identity Submitted

B. ADDRESS DETAILS

Residence Address

City/Town/Village

Pin Code

State

Country

Contact Details

Specify the Proof of Address Submitted for Residence Address

Your Photo Must be in Passport (PP) Size. Max Upload Size 1MB.

Permanent Address (if different from above or overseas address, mandatory for Non-Resident Applicant)

DECLARATION

I hereby declare that the details furnished above are true and correct to the best of my knowledge and belief.

I undertake to inform you of any changes therein, immediately. In case any of the above information is found to be false or untrue or misleading, I am aware that I may be held liable for it.

Signature of the Applicant

Date (dd/mm/yyyy)