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Univ. Enrollment No*

Confidential No.

Category*

Cast Certificate No.*

12th Stream

Class

Stream*

Name of the Candidate*

Date of Birth

Email ID*

Gender*

Mobile No.*

Father's Mobile No.

Aadhaar No.*

Father's Name

Mother's Name

Blood Group

Year*

Religion*

Sub Category*

Minority*

Caste

Nationality

father Occupation

Marital Status

Permanent address*

Same as Permanent Address

Current Address

Period of residing in u.p.*

State of Passing Intermidiate

State of domicile

I Agree with the Admission Rules and Regulations.