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Name of the Candidate :
Name of the Father :
Name of the Mother :
Sex :
Date of Birth :
Day  Month  Year 
Age :
Religion :
Nationality :
Current Address :
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Line 2 :
City:
Pin Code:
State :
Country :
Phone No :
Mobile :
Permanent Address :
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City:
Pin Code:
State :
Country :
Phone No :
Mobile :
Your E-Mail :
AIEEE Rank & Roll No :

Preferences of Branch
of Engineering (1,2,3 or 4)
in order of preferences :
Computer Sci & Engg.
Electronics & Comm. Engg.
Mechanical Engg.
Information Technology
Civil Engg.
Father's Occupation : Business / Service / Self Employed
Designation :
Company Name :
Educational Qualification :
S.No Exam Padded Board/University
With Roll No.		 Year Div. % age of Marks Subject Offered
1. Class X
2. Class 10 + 2
3. Diploma in Engg. with Branch


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