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Personal Details

Name*

Permanent Address

House*

Post*

District*

Pin*

Email*

Mobile Number*

Communication Address

House*

Post*

District*

Pin*

Gender* MaleFemaleTransgender

Age*

Date of Birth*

Place of Birth*

Identity Card Type* AadhaarOther

Family Details

Name of Father

Occupation of Father

Name of Mother

Occupation of Mother

Name of guardian*

Relationship with guardian*

Contact Number of Guardian*

Type of family BPLAPL

Religion & Community

Religion* ChristianHinduMuslimOthers

If Catholic Specify Whether Dalit Catholic YesNo

Community* SCSTOBCOECNot Applicable

Educational Qualifications

Stream BABSCMBBSBtechOthers

Name of the College

Year of passing(Graduation)

Do you have PG qualification? YesNo

If Yes, Specify Stream,College and Year

Are you employed? YesNo
If employed, Gazetted or not? GazettedNon-gazetted

Upload Your Photo* (Use Only jpg/png/jpeg file below 500 KB)

Undertaking

I agree with the features, conditions, rules and policies of the KAS Coaching Programme. I also undertake that I will abide by the rules and regulations of the Institute as well as instructions issued by authorities from time to time.

Details of Fee paid for provisional admission:

Amount*

Date*

Name of the account holder*

Details of balance fee, if any, paid for regularizing the admission.