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PHONE No.(Res) / MOBILE NO.Applicant’s Mob No.__________________Phone No. Residence ________________Fa<strong>the</strong>r’s Mob No.___________________Mo<strong>the</strong>r’s Mob No.___________________Fa<strong>the</strong>r’s email address_______________Mo<strong>the</strong>r’s email address_______________PERMANENT HOME ADDRESS:CURRENT ADDRESS (if different from Permanent Address):SECTION–III ACADEMIC RECORDCertificate Year Reg. No. RollNo.MarksDiv/GradeSubjectsName ofBoard/UniversityMatric/O LevelFA/FSc/ A. LevelBS (16 years ofeducation) ORBA/BSc &MA/M.Sc. (16years ofeducation)MS/MPhilSection–IV GAT TEST RESULTGAT ROLL NOGATREGISTRATIONNOGAT (TYPE) MONTH YEAR CENTRE TESTSCORESection–V DESCRIPTION OF RESEARCH WORK (BS/MSc, MS/M.Phil.)TITLE OF THESIS/REPORT SUBJECT YEAR INSTITUTION

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