| Student Name* |
First Name: Middle Name: Last Name: |
| Date of Birth* |
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| Name of Father / Guardian* |
|
| Occupation of Father
/ Guardian* |
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| Educational Qualification |
|
| Name of Board / University* |
|
| Total Percentage / Grade * |
|
| Name of Board / University |
|
| Name of Board / University |
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| Hostel Facility Required* |
|
From where did u heard about
APIM?* |
e.g. Newspaper, Friends, Family, T.V. Chennal etc. |
|
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| Please tick the
mode of payment*
DD
MO
|
| Bank Name / Post Office * |
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