Vepsun

PERSONAL DETAILS

Title *

First Name *

Last Name *

Mobile No. *

Email ID *

Course *

Gender *

Family's Details

Marital Status

Father's Details

Father's Name *

Father's Mobile No *

Father's Email Id

Father's Occupation

Mother's Details

Mother's Name *

Mother's Mobile No *

Mother's Email Id

Mother's Occupation

ADDRESS FOR COMMUNICATION

Pincode *

Country *

State *

District

City *

Correspondence Address Line 1 *

Correspondence Address Line 2

Academic Details

Current Education Qualification Status *

Candidate's Name as in 10th Certificate *

10th Details *

Institute Name	Select Board	Marking Scheme	Percentage / CGPA	Year of Passing

12th Details/ Diploma Details *

Institute Name	Select Board	Marking Scheme	Percentage / CGPA	Year of Passing	Stream

Graduation Details *

Institute Name	University / Board	Marking Scheme	Percentage / CGPA	Year of Passing	Degree

Post Graduation Details *

Institute Name	University / Board	Marking Scheme	Percentage / CGPA	Year of Passing	Degree

Declaration

I certify that the information submitted by me in support of this application, is true to the best of my knowledge and belief. I understand that in the event of any information being found false or incorrect, my admission is liable to be rejected / cancelled at any stage of the program. I undertake to abide by the disciplinary rules and regulations of the institute.

Applicant Name *

Parent Name *