Hind Di Chadar

Applicant Name: *

Upload Photo: *

Father Name: *

Mother Name: *

Date of Birth : *

Is Resident of District Rupnagar, Punjab: *

Caste : *

Gender: *

PWD (Person with Disability): *

10th Board Exam Marks Obtained : *

Maximum Marks: *

Percentage/ CGPA:*

Roll No : *

10th Exam Passed Year : *

Name of the School: *

Email id : *

Mobile No : *

Address for Correspondence: *

Pin-code: *

Tehsil: *

District: *

State : *

Name: *

Mobile No: *

Relation with applicant : *

Profession: *

Annual Income : *

Please attached the scanned copy of the certificate of merit: *

The information furnished by me is complete and correct. I bear the complete responsibility for all the above information provided.

Applicant Signature: *

Parent Signature: *