KC Pullaiah Foundation -

General Information

Name

Gender

Male

Female

others

Date of Birth

Age

Applicant Contact Number

Applicant Email Id

Applicant Aadhar No

Attach Aadhar Card

Aadhar Card

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Attach Cast & Religion Certificate

Cast & Religion

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Father Name

Father Mobile Number

Mother Name

Mother Mobile Number

Guardian Name

Guardian Mobile Number

Category SC/ST/OBC/OC

Are you Physically Handicapped / Challenged

Yes

No

Present Address

House/Flat Number

Street/Apartment

Area/Locality

City

District

State

Pin Code

Permanent Address ( Same as Present Address)

House/Flat Number

Street/Apartment

Area/Locality

City

District

State

Pin Code

Academic Information

Highest Acadamic Qualification

Branch

Attach Marks Memo Documents

SSC

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Intermediate

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Graduation

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Post Graduation

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I confirm all the information provided above is correct.