Transaction no.

 

Name

 

Date of Birth (dd/mm/yyyy)

 

Gender

Male Female Other

 

Category

General ST SC OBC Non Creamy Layer

 

Divyaang (Physically Challanged)

No Yes

 

Member of G.E.L. Church

No Yes

 

Religion

 

Nationality

Indian Other

 

Father

 

Mother

 

Contact No. 1

 

Contact No. 2 (optional)

 

Email ID

 

Permanent Address

 

Correspondence Address

 

Blood Group

A + A - B + B - O + O - AB + AB -

 

Mark of Identification

 

Name and Address of College last attended

 

Class Roll No. last attended (if Gossner College, Ranchi's Student)

 

Married

No Yes

 

Yearly Income of Father / Gaurdian

 

Name of the State to which you belong

 

Nearest railway Station

 

Subject Applying for

Physics Chemistry Maths Zoology Botany Geology

 

Examination	University	Year	Total % of Marks	Marks obtained in applied subject

 

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