I   Candidate's Information:
1.	Name of the Student in full (Block Letters):
2.	Place of Birth:
3.	State:
4.	District:
5.	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 January February March April May June July August September October November December Year 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002
6.	Sex:	Male    Female
7.	Blood group:
8.	Present Address for communication:
9.	Permanent Residential Address:
10.	Phone No. Office  (With code):
11.	Phone No .Residence (with code):
12.	Mobile No:
13.	E-mail id:
14.	Guardian's Name & Occupation with Address:
15.	Annual Income of the Parents/Guardian (Rs):
16.	Nationality:	Indian  NRI  Foreigner
17.	Caste:
18.	Sub Caste:
19.	Religion:
20.	Category: SC / ST / I / IIA / IIB / III A / III B / PH / GM / OTHERS:
* Note:     1. PH-Physically Handicapped 2. Candidates claiming admission under Reservation should submit : Photocopies of the concerned caste/income certificate, failing which they will be classified under GM Category.
21.	Particulars of passing in the Degree Examination Course and Combination
22.	Name of the Institution last attended and University
* Note : If applicant is a foreign student attach the following:
Provisional Eligibility Certificate issued by the Registrar, University of Mysore. Medical Certificate. Photocopy of passport showing visa details etc. The foreign students shall have the visa for the total duration of the course.
23.	Hostel facilities required	Yes  No
24.	* Enclosures: Degree mark card and certificate Transfer Certificate - ORIGINAL AND ATTESTED PHOTO COPY Cast/Income Certificate- ORIGINAL AND ATTESTED PHOTO COPY

25.	Please provide any other information which may be useful to us in considering this application:
*	Provide Certificates at the time of Admission, without which, the admission stands cancelled.