Date of Birth*

Name*

Year of entry—Please choose an option—202520242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963

Leaving year*—Please choose an option—202520242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963

Leaving class*—Please choose an option—VIVIIVIIIIXXXIXII

House*—Please choose an option—MAGADHGAUTAMARYABHATTVIKRAMPATLIPUTRAVAISHALIMITHILAASHOKAKUNWARASHOKAMAURYARAJGIRNALANDABAIDYANATHPARASNATH

Email ID*

Contact No

Occupation

Address

Spouse

Blood GroupA+A-B+B-O+O-AB+AB-

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