* DENOTES MANDATORY FIELDDCG DATA-CORE SYSTEMS (INDIA) PRIVATE LIMITED VERSION 7.0

NAME OF THE CANDIDATE * FATHER / GUARDIAN'S NAME *

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ADDRESS DISTRICT * SUBDIVISION *

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PINBLOCK / MUNICIPALITY * POST OFFICE * GENDER *

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DATE OF BIRTH * (DD-MM-YYYY) SC/ST * SUB-CASTE /SUB-TRIBE *

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CASTE/TRIBE CERTIFICATE NO ISSUE DATE (DD-MM-YYYY) ISSUING AUTHORITY DISTRICT

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ISSUING AUTHORITY SUB-DIVISION ANNUAL FAMILY INCOME * MOBILE NO *

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LAST CLASS PASSED * YEAR OF PASSING * CLASS READING IN *

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% OF ATTENDANCE IN LAST SESSION *

BANK NAME * IFSC *

BANK BRANCH NAME * BANK ACCT NO. *