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General Instruction for Applicant 1. An applicant can modify its application form at any point of time before due submission date & time. 2. Only in case of modification in priority location/seat, the time of latest modification will be recorded and considerd as final time of submission for all future refrences, which will also be used for allotment of seat on first come & first serve basis. Cumulative Percentage Declaration I hereby declare that the above furnished details are true to the best of my knowledge. In case any of the above information is found to be false or misleading, I may be held liable for it. Signature Course Year Semester University Roll Number College Name Degree Programme Type Degree Programme State Pincode Current Education Details University Name Address Detail's Address Line 1 Address Line 2 District Category Mobile Number Email Id Father Name Photo Mother's Name Guardians Name Date of Birth Gender Last Seat Change Date Seat Status Personal Detail's Candidate's Name Area of Intrest Organization Application Submission Date STATE URBAN DEVELOPMENT AGENCY,CHHATTISGARH 4th floor, D-Block, Indravati Bhawan, Naya Raipur (c.g.) Phone No 0771-2222404 / Fax No 0771-2222409 Email : [email protected] Draft Application Form Application Number

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Page 1: STATE URBAN DEVELOPMENT AGENCY,CHHATTISGARHcitycaptainclean.org/Online_Application/Upload/NOC_format.pdf · STATE URBAN DEVELOPMENT AGENCY,CHHATTISGARH 4th floor, D-Block, Indravati

General Instruction for Applicant

1. An applicant can modify its application form at any point of time before due submission date & time.

2. Only in case of modification in priority location/seat, the time of latest modification will be recorded and considerd as final

time of submission for all future refrences, which will also be used for allotment of seat on first come & first serve basis.

Cumulative Percentage

Declaration

I hereby declare that the above furnished details are true to the best of my knowledge. In case any of

the above information is found to be false or misleading, I may be held liable for it.

Signature

Course Year

Semester

University Roll Number

College Name

Degree Programme Type

Degree Programme

State

Pincode

Current Education Details

University Name

Address Detail's

Address Line 1

Address Line 2

District

Category

Mobile Number

Email Id

Father Name

Photo

Mother's Name

Guardians Name

Date of Birth

Gender

Last Seat Change Date

Seat Status

Personal Detail's

Candidate's Name

Area of Intrest

Organization

Application Submission Date

STATE URBAN DEVELOPMENT AGENCY,CHHATTISGARH

4th floor, D-Block, Indravati Bhawan, Naya Raipur (c.g.)Phone No 0771-2222404 / Fax No 0771-2222409 Email : [email protected]

Draft Application Form

Application Number

Page 2: STATE URBAN DEVELOPMENT AGENCY,CHHATTISGARHcitycaptainclean.org/Online_Application/Upload/NOC_format.pdf · STATE URBAN DEVELOPMENT AGENCY,CHHATTISGARH 4th floor, D-Block, Indravati