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I .• • @tt"lt11JG m, ~ 6 ~ 2013 370 (33) Address for Correspondence ·····••.•·········· ....... ··········· ··························:·····••.•··············· Village/City ......................................... ,,_ ...................... . ·Ward No./Gram Panchayat ......................................... . Block ................................. District ............................. .. State ............. : ................. Pin Code ........ , ......... ,,· ........... . Telephone No. for Contact (if any) ························································:···'-·;: .. · ................... . Mobile No. for Contact (if any) . . . -·:·.··:•:, .. ••············································································ - E-mail (if any) . ···-i-···:··················································""····· ................ . I Occupation of the Applicant . .... · ................................................................................... . Family Occupation . . . ························"······························································ Annual Income of the Family , .. • ............... · ....... ~ .............................................................. . Ae,ademic Qualification : Name of ~xamination Year of Passing Name of Board/ Percentage of . ,. .• .. University Marks or Grade 5tb Standard .. , I ' 8th Standard · I I 0th/Matriculation / I 12th/Higher Secondary ' Graduation .. Post Graduation . / ' Other . Technic~J/Prof~ional Qualification: Vocational Education and T~aining/ITI/Diploma/Engineering/Man- agement/Medical and Nursing/Pharmacy/Other S.No. Qualification Trade/Branch/ Name of Board/ Duration Yearof Percentage. Stream University (In Years) Passing of Marks or Grade