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COURSE CATEGORY-
Diploma in Medical Laboratory Technology Diploma in Anaesthesia Technology
ECG Technician X-ray Technician ICU Technician
Diploma in Health Inspector Technology in C.T.Scan Diploma
1.STUDENT NAME

2.FATHER'S NAME

3.MOTHER'S NAME

4.RELIGION

CAST/SUB CASTE

NATIONALITY

PLACE OF BIRTH

5.DATE OF BIRTH

6.MOTHER TONGUE OF STUDENT

7.PARENT'S PROFESSION

8.ADDRESS

PINCODE

TELEPHONE.NO.RES

OFF

9.BLOOD GROUP:

10. TRANSFER CERTIFICATE / LEAVING CERTIFICATE OF ORIGINAL COPY SHOULD BRING ALONG WITH THE CANDIDATE.
11.ORIGINAL MARKS CERTIFICATE OF 10thOR 12th
REPORTS TO THE INSTITUTE
DATE


PARENTS SIGNATURE

_____________________________
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