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Student Name
Father's Name
Mother's Name
Date of Birth
Date
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Month
jan
feb
mar
apr
may
june
july
aug
sep
oct
nov
dec
Year
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
No of Brothers/Sisters
Father's Occuption
Annual Income
Select Income
below 1 Lac
1lac to 3Lac
Above 3Lac
Course Applied for
Select Class
Class VIII
Class IX
Class X
IIT-AIPMT
Name of Last School
Medium
Last Year percentage
%
Aadhar No
Mobile No.
Address
Reference Person Name
Reference Person No
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