FIELDS MARKED WITH * ARE REQUIRED! Name of the Candidate :* Father’s / Guardian’s Name :* Date of Birth : Address : Father’s/ Guardian’s Occupation : Father’s/Guardian’s Annual Income : Permanent Address : Address for Communication : Pin / Zip : Telephone No. / Mobile No. : Email Id : Marks obtained in Xth/ SSC /Matriculation : Suggestions / Comments : After you have submitted this form, kindly send us the following by post or courier: i) Certified true copy of Marks Sheet of Xth/ SSC/ Matriculation. ii) Proof of appearance in XIIth/ HSC/ Intermediate Examination. (Marks Sheet of XIIth/ HSC for students who are pursuing their graduation course) iii) 2 passport size colour photographs. iv) Demand Draft of Rs. 200/- in favour of “UmmulQura” payable at Pune. Note: This application is only for admission test. It does not guarantee the selection of the candidate under the scheme. Please check the details you have entered and to submit form. Home
Name of the Candidate :* Father’s / Guardian’s Name :* Date of Birth : Address : Father’s/ Guardian’s Occupation : Father’s/Guardian’s Annual Income : Permanent Address : Address for Communication : Pin / Zip : Telephone No. / Mobile No. : Email Id : Marks obtained in Xth/ SSC /Matriculation : Suggestions / Comments :
