| 1. Name of the candidate in full (block letters) to be entered as found in the certificate of the qualifying examination. * |
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| 2. Father’s Name |
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| 3. Mother’s Name |
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| 4. Name of the guardian and relationship (if father is not alive) |
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| 5. Permanent address of father or guardian |
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| 6. a) Telephone Number * |
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| b) Email Address * |
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| 7. Religion and Caste |
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| 8. Whether you belong to Scheduled Caste / Scheduled Tribe / Backward Class. State sect if you belong to Any one of these categories. |
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| 9. Occupation of Father / Guardian |
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| 10. Annual Income of Father / Guardian |
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| 11. a] Date of Birth (In Christian era) |
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| b] Place of Birth (Here enter Place, Taluk & District) |
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| c] State of domicile |
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| d] Mother tongue |
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| e] Languages which you can read, write and speak |
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| 12. Are You – |
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| a] A citizen of Indian Union? If not mention nationality |
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| b] Native of Karnataka State? If not, to which state do you belong? |
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| c] Have you applied to the Rajiv Gandhi University for Eligibility Certificate? |
Yes No |
| 13. Academic Particulars |
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