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PROFESSIONAL PROFILE
Name * 
Sex
Date of Birth / / * 
Age (as on 01 July, 2007)
Father's Name
*
Course Interested for 1.
*
  2.
  3.

EDUCATION QUALIFICATION
Exam Passed Univ. / Board School / College Yr. of Passing % Marks Remarks
Matric
10+2 Total
PCB/PCM
Diploma
Graduation
Post Graduation
Others

Admission Category
Entrance Test Rank :
Name of the last attended Institution
Place :
Student Category Seat Claim
General   SC   ST   OBC  
None   Others
Punjab Domicile
All India Basis

Address for Correspondence* Contact Numbers
H No / Building Residence *
Colony / Village   Office
Town / City   Parent’s Mobile No
District   Parent’s E-mail ID
State / UT   Self Mobile No
Country   Self E-mail ID
Pin / Zip      
 
Do you want to avail hostel facility (Optional) Yes No
If Yes Two Seater Three Seater Four Seater
 
Do you want to avail bus facility? (Optional) Yes No
If Yes City   Boarding
 
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Jalandhar-Ludhiana G.T. Road, Phagwara
Telephone +91-98767-44338, 500777

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