BHEEMIREDDY INSTITUTE OF MANAGEMENT SCIENCE

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Name of the Candidate:

Name of the Father(or Guardian if Father is not alive):

Name of the Mother:

Sex:

Male Female

Email:

Mobile No:

Aadhar No:

Address for Communication:

Present Address:

Date of Birth as per SSC or equivalent
(enclose attested copy):

Branch applied for(tick the appropriate Branch)
(enclose attested copy):

Nationality & Religion:

Cast & Category:

Mother Tongue:

Identification marks of the candidate as given in the school records:

Name of the Qualifying Examinaiton:

University/Board/Authority which conducs the Examination:

Month & Year of Passing:

Registration No:

Overall percentage of marks obtained at the Qualifying Examination No:

Qualified ICET or Not:

ICET Hallticket No:

Rank:

Particulars of Parent/Guardian (Guarding only if father is not alive):

Name:

Relationship with candidate:

Profession with Designation:

Annual Income from all sources:

Address for communication
(Give phone number ,if available):

Address & Phone number of local Guardian, if any
(Give phone number ,if available):