St Justins College of Education

UMIS No. :

EMIS No :

Photo Upload :

Name in English (Block Letters) :

Date of Birth :

Age :

Mobile Number :

Aadhar No :

Email :

Category :

Caste :

Mother Tongue :

Religion :

Marital Status :

State :

Name of the Father/Guardian :

Cell No :

Educational Qualification :

Occupation :

Annual Income :

Name of the Mother :

Cell No :

Educational Qualification :

Occupation :

Annual Income :

Address :

Door No :

Street Name :

Area :

Land Mark :

State/Union Territory :

District :

Taluk :

Village :

Block :

Village Panchayat :

Pincode :

Are you physically handicapped? :

Nature of handicap :

Percentage :

Certificate No :

Are you a first Graduate in your family? :

Certificate No :

Are you a daughter of an Ex-serviceman? :

Identity of the Candidate I :

Identity of the Candidate II :

Year of Passing :

Details of 10th std passed (Specify 10th) Reg.No :

Year of Study :

Mark obtained :

Details of 12th std passed (Specify +2) Reg.No :

Year of Study :

Year of Passing (DD/MM/YYYY) :

Mark obtained :

Blood Group :

Details of UG Degree (Specify the Degree) :

University :

Major :

Year of Study :

From :

To :

Month/Year if Passing Qualified :

Percentage of Marks (%)(Rounding off Marks to next Integer is not permitted) :

To :

Details of B.Ed Degree

University :

Major :

Year of Study :

From :

To :

Month/Year if Passing Qualified :

Total Marks obtained :

Maximum Marks (Total) :

Percentage of Marks (%)(Rounding off Marks to next Integer is not permitted) :

X Mark Statement :

XI Mark Statement :

XII Mark Statement :

UG Mark Statement :

PG Mark Statement :

UG Provisional :

UG Covocation :

PG Provisional :

PG Covocation :

TC :

Community Certificate :

Nativity Certificate :

Aadhar :

Personal Bank Pass Book 1st Page :

First Graduate Certificate (if applicable) :

Income Certificate :

Amount :

Date Field :

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