CLASS:

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NAME (CAPITAL LETTER):

SCHOOL NAME:

EMERGENCY CONTACT NUMBER:

MOTHER’S NAME:

OCCUPATION:

MOB:

FATHER’S NAME:

OCCUPATION:

MOB:

BLOOD GROUP OF STUDENTS:

LAST EXAM MARK PERCENTAGE:

ADDRESS:

PIN CODE:

DISTANCE FROM INSTITUTE:

FACILITY REQUIRED: HOSTEL TRANSPORT SELF

I Trupti Pradhan hereby declare that the above given information filled is true to best of my knowledge and I agree to abide by the institute rules and regulations.

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