S.S INSTITUTE OF PROFESSIONAL EDUCATION


 

Application No.:


 

Study Center Code:

 
 

Course for Applied:

 
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Candidate Name:{as per Matriculation Certificate}
 
 
 
Sex:
 
Date of Birth:
 
 
Address for Correspondence (do not repeat name):
Phone no. with STD code:
Mobile No:
E-Mail:
  
Employment Status:
 
Nationality:
 
 
Category (Gen/ SC/ST/ OBC)
 
Details of Education Qualification (From Matriculation onwards)

DECLARATION

I hereby declare that,the information furnished here in above is true and correct to the best of my knowledge and belief. I further declare that the attested photocopies of the certificates submitted by me at the time of admission are the true copy of originals. I have read the prospectus nad the rules and regulations of University. In case any information is found incorrect,at any stage, I agree to for go the fee deposited the fee deposited and also the claim for addmission.

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Signature of Applicant

 

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