Full Name as in SSLC Book (in block letters) :
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Name in Malayalam :
Sex :	Male Female
Marital Status :	Single Married
Age :
Date of Birth :
Place of birth :
Nationality :
Religion, Caste / Community (SC/ST) as in SSLC Book :
Present Address :
Land Phone :
Mobile :
Pincode :
Aadhaar No :
Name and Address of Parent :
Land Phone :
Mobile :
Pincode :
Occupation and income of the Parents :
Occupation :
Annual Income Rs :
College in which the applicant had studied with period of study
Details of Qualifying Exam :
Reg.No :
Year :
No. of Chances :
Subjects and Marks of Qualifying Examination: