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Date: [Select/Type Todays Date] Your Full Name: [Type your full name starting with surname] Parent's/Father's Full Name: [Type your Parent's/Father's full name starting with surname] Gender: Date of Birth: Contact Address : Blood Group : Contact No.(Self) Contact No.(Parent) Email : College/School Name : Standard/Branch/Division: Previous Participation in any Social Activity: Describe Activity :

Loknete Hon. Hanmantrao Patil Charitable Trust's
Adarsh Group of Institutions, Vita