Indian Institute of Technology Kharagpur
Name of the Candidate (As in 10th Class Certificate) 
Nationality Indian   Foreigner
Gender Male   Female
Category SC   ST   OBC (Non-creamy)   GEN
Person with Disability Yes   No
Date of Birth [dd-mm-yy] - -
Name of Father/Mother/Guardian
Relationship Father   Mother   Guardian
EXAMINATION CITY
Examination City :
DETAILS OF QUALIFYING EXAMINATION
Qualifying Degree                    Internship
Year of Qualifying Exam    (yyyy)     Percentage       CGPA (out of 10)
Mathematics at +2 Level
DETAILS OF CONTACT ADDRESS
Address
Pin Code   
Email  
Phone -     Mobile No:
               STD Code            Number              Mobile number must start with zero
DETAILS OF DEMAND DRAFT
Payment Details
                DD No.[Numeric]Nationalised Bank Drawn On  OtherDate [dd/mm/yyyy]Amount
           

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