STATE PARAMEDICAL COUNCIL LUCKNOW

Name of The University/ Council *

Stream *

Course *

Name Of Applicant *

Father Name/ Gurdian's Name *

Mother Name

Gender *

Male Female Other

Martial Status *

Single Married

Cast *

Date Of Birth *

Aadhar Card *

Nationality *

Permanent Address *

Contact No. *

Postal Address

Contact No.

Qualification

S. no.	Examination Passed	Name Of College	Year	Board Council	Division
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2
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5

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I hereby certify that particulars furnished above are correct. I under take to abide by the rules laid by instructions. I promise to obey & follow all the rules and regulation in structured in prospectus.

Admisssion Form

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