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ARDIAN S * NAME (*in case of orphan) As given in Class X mark sheet SEX: MALE FEMALE Tick the appropriate HANDICAPPED Tick the appropriate SUBJECT 1 SUBJECT 2 (with code) SUBJECT 3 (with code) SUBJECT 4 (with code) SUBJECT 5 (with code) ADDITIONAL SUBJECT (with code) ANNUAL INCOME OF MOTHER & FATHER (in numeric s) ONLY CHILD OF PARENT Tick the appropriate DETAILS OF CLASS X EXAM PASSED CASTE: GENERAL Tick the appropriate N.A Blind Deaf SC ST Handicapped OBC Dyslexic Spastic 101 FU.

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