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APPLICATION FORM

Sr. No.

Item

 

Complete Information

1

Full name (in Block Letters). Beginning with surname

:

 

2.

Name & Present Postal Address: (of Father, Husband of Guardian)

:

 

3.

Date of Birth (Enclose Certificate in support)

:

 

4

Sex

:

 

5.

Place of Birth, Indicating the District & State in India (with a certificate of Nationality & Domicile

:

 

6.

Occupation of Father, Husband or Guardian

:

 

7.

Name & Permanent Address of Father, Husband or Guardian.

:

 

8.

Guardian’s Full name (if Father / Husband is not alive)

:

 

9.

Relationship with Guardian

:

 

10.

Occupation of Guardian

:

 

11.

Permanent Postal Address of the Guardian

:

 

12.

Are you Married / Unmarried / Widow / judicially separated / Divorced.

:

 

13.

Occupation of Husband, if Alive

:

 

14.

Number of Children, if any, and their ages

:

 

 

15.       ACADEMIC QUALIFICATIONS   

Examination

Name & Address of the School

Year of Passing

At What Attempt

% age of Marks

Total

X STD (SSC)

 

 

 

 

 

XI STD

 

 

 

 

 

ANY FURTHER EXAMINATION

 

 

 

 

 

 

NOTE: In support, please attach copies of Mark-Sheet

16.       LANGUAGE PROFICIENCY: Kindly tick () appropriately

YES, I Can

MARATHI

HINDI

ENGLISH

SPEAK

 

 

 

READ

 

 

 

WRITE

 

 

 

 

 

 

Signature of the Applicant

Date:

Place:

 

 

 

The application is duly endorsed by me. I have no objection if my ward/wife undergoes the trainings.

 

Signature of Father/Husband/Guardian.

Date:

Place:

 

 

 

   
 
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