Distance Learning

Applied For *

Candidate Name *

First

Middle

Last

Father's Name *

Mother's Name *

Date of Birth *//

Sex *

Mobile Number / Landline No. *

Mobile Number / Landline No. (Alternate phone)

E-Mail ID *

Permanent Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Correspondence Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Qualifying Exam Details *

Name of The University *

Year/Session *

Obtained Marks

Total Marks *

% age

Declaration *

Please check to confirm the declaration

I do hereby declare that the particulars given above are correct to the best
of my knowledge & affirm that my son/daughter is liable to be disqualified
if any discrepancy is found in the above information

SBDEDU

Seth Banarsi Dass College of Education

Kurukshetra

Seth Banarsi Dass College of Education

Kurukshetra

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