Cf AS/Application No: PlP Pg/ Government of Karnataka

z Pt ES / Department of Pre-University Education x/wAi Ai zRw Cf/ I/II PUC Admission Application Form 2015-16

Pbj GAiUPV iv / For Office use only

1. zRw AS/ Admission No

2. sU - AAid/Languages cum- combination. 3. izs/ Medium Pq/Kannada EAV/English 4. sU/ Section 5. w U/ Reservation category

1. zyAi t g/

Name of the Student in English as entered in SSLC marks card

(CAPITAL LETTERS ONLY). 2.a)nz AP / DATE OF BIRTH DAY MONTH YEAR. 2.b) AU/Gender : qV/Female or qU /Male 3.a) zs/Religion. 3.b). ew / Caste: 3.c). Gew / Sub Caste:

4. zyAi SAiA /Permanent Address. jP /Correspondence Address

Candidates Address Tel No/Mobile No:

5. zyAi v v vAzAi g: v/ Mother Name of the Parents : vAz/ Father

6. Pg g v : Name of the Gaurdian with Address :

7. Pg P DzAi : DzAi it v UwzAii? yes

Parents Annual Income : Is Income Certificate enclosed No

8. F Az AU irz /P f g v Name and address of the School /College last studied. 9. vUqAiiz JJJ/vvi jP g Azt AS /Reg No:

Particulars of SSLC /equivalent examination passed. /Year: wAU/month __ ____ ____ ___ ____ ____ ____ ________ cut here ____ ___ ____ ____ ____ ____ ___ Pig/ Pij ______________________________________ gjAz _____________________ AAidU x / wAi AiU CfAi qAiVz.

/Place: AP/ Date: Cf Pjzg

Ewa s av CAn

Affix recent pass port size photograph

Govt. PU College, Devalapura