| APPLICATION ID /REGISTER NUMBER |
|
|
| NAME |
|
DEGREE
|
|
| COURSE |
|
| COLLEGE/DEPARTMENT NAME |
|
| CATEGORY |
|
SOCIAL WELFARE NO.
|
|
| DATE OF BIRTH |
|
| EMAIL* |
|
| CONTACT NUMBER* |
|
| FATHER NAME* |
|
MOTHER NAME* |
|
| GUARDIAN NAME |
|
RELATIONSHIP(IF GUARDIAN) |
|
| CASTE CERTIFICATE* |
|
Digit RD Number of Caste Certificate* |
|
| INCOME CERTIFICATE* |
|
Digit RD Number of Parent's Income Certificate* |
|
| FEE PAID AT* |
|
|
|
| RECIEPT NUMBER* |
|
RECEIPT DATE* |
|
| HOUSE NO* |
|
| STREET * |
|
| LOCALITY/VILLAGE* |
|
HOBLI
|
|
| STATE* |
|
DISTRICT*
|
|
| TALUK* |
|
PIN CODE*
|
|
| DISTANCE FROM HOME TO COLLEGE (AS PER DISTANCE CERTIFICATE) |
|
| PRESENT ADDRESS* |
|
| ADDRESS OF THE LOCAL GUARDIAN* |
|
| PHONE NO. OF THE LOCAL GUARDIAN |
|
| YEAR/SEMESTER |
|
| HOSTEL NAME |
|
| FEE AMOUNT*
|
|
Information About BCM Hostels
(Only First Year PG students can apply) |
| Applied for BCM Hostels
|
|
| REMARKS |
|