Application Form

Mobile Number*

Email Address*

Name of the Applicant as shown in certificate*

Date of Birth*

Gender*
MaleFemaleOther

Domicile State*
Andhra PradeshArunachal PradeshAssamBiharChhattisgarhGoaGujaratHaryanaHimachal PradeshJharkhandKarnatakaKeralaMadhya PradeshMaharashtraManipurMeghalayaMizoramNagalandOdishaPunjabRajasthanSikkimTamil NaduTelanganaTripuraUttar PradeshUttarakhandWest Bengal

Nationality

Religion

Caste

Category
SCSTOBC-Non CreamyOBC CreamyOthers

Father's/Guardian’s Name

Father's/Guardian’s Occupation

Father's/Guardian’s Contact Number

Mother’s Name

Mother’s Occupation

Mother’s Contact Number

Parents Annual Income

Permanent Address

Address For Communication

Examination

Institution

Year of Passing

Marks %

Examination

Institution

Year of Passing

Marks %

Course

Type
Full TimeRegularPrivateCorrespondence

Institution

University

Year of Completion

Marks Obtained

Percentage

10th Standard Certificate (Max:1mb)

12th Standard Certificate (Max:1mb)

Degree Certificate (Provisional) (Max:1mb)

Degree Certificate (Final) (Max:1mb)

Degree Semester 1 Mark list (Max:1mb)

Degree Semester 2 Mark list (Max:1mb)

Degree Semester 3 Mark list (Max:1mb)

Degree Semester 4 Mark list (Max:1mb)

Degree Final Mark list (Max:1mb)

Migration Certificate (if not from Kerala Univ.) (Max:1mb)

Transfer Certificate (Max:1mb)

Conduct Certificate (Max:1mb)

Upload Photo (150px X 180px) (Max:500kb)

Upload Signature (300px X 100px) (Max:500kb)

Roll No.

Test Date

Composite / Total Score

Rank

Roll No.

Test Date

Composite / Total Score

Rank

Roll No.

Test Date

Composite / Total Score

Rank

Mode of Payment
Cheque/DDOnline Payment

Transaction Details

Amount

Date

Bank

I hereby declare that all the information provided in this form are true to the best of my knowledge. I understand that any misrepresentation by me in this application will disqualify my candidature at any point of time.