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I. PERSONAL DETAILS:

a) Name of the Candidate in full (In block letters):

b) i. Father's Name: *

ii. Qualification: *

iii. Occupation: *

iv. Contact No :*

c) i. Mother's Name: *

ii. Qualification: *

iii. Occupation: *

iv. Contact No : *

d) Gender:MaleFemale

e) Date of Birth:

f) Place of Birth: *

g) Aadhaar Number: *

h) Nationality: *

i) Religion & Category: *

j) Place of Residence: *

k) Permanent Address :*

l) Address for Correspondence : *

m) Student Phone Number: *

n) Email Address: *

II. a) Educational Details:

b) Achievements:

1)

2)

3)

Note: All applications must be accompanied by attested Certificates. Submit the attested certicates in the ofiice.

I hereby declare that the above information furnished by me is true and correct to the best of my knowledge, I promise to provide all the documents required in support of the same.

Place:*

Date:*

BANK DETAILS:

KLES Principal BBA College, Dharwad

Branch: NTTF Branch, Dharwad

S.B.A/c No.: 89330100016725

IFSC Code: BARB0VJDHMA

Enter Amount (Fees Min Rs. 8000): *

Screenshot of the payment/Image Upload: *