rocky - Application Form

NOTE : INCOMPLETE FORMS WILL NOT BE ACCEPTED

Affix
Photograph
here
(1)

Affix
Photograph
here
(2)

1. Name__________________________________________________.

2. Date of Birth (in words) ___________________________________________.

3. Occupation______________________________________________________.

4. Permanent Address_______________________________________________

Pin : - ________________________.

Telephone with STD Code_______________E-mail ______________________.

5. Telephone with address and next of kin, Parent/Guardian (in the event of an accident)

Name__________________________________________________.

Address________________________________________________________

Pin Code_____________________. Tele No. _________________________.

STD Code____________. Fax _____________. E-mail ______________________.

6. Vegetarian or Non-Vegetarian

_________________________.

Date________________.

7 .	I hereby certify that all the entries are correct in every respect. In case of deaths, accident or injury of any form, the Institute or any of its staff will not be held responsible in any manner wholly or partially.

Signature _____________________ .

Date 1. _________________. 1. Applicant ___________________.

Date 2. _________________. 2. Parent/Guardian ______