*Name :

*Email :

*Date of Birth :

*Qualification :

Address :

Phone (Res) :

Mobile :

AADHAR No. (If Available) :

Parent / Gaurdian Name :

Parent / Gaurdian Contact No :

Have you undergone any vocational/skill under STAR or PMKVY ?

If yes, Name the Training Institute :

Mention the course :

Are you a working Professional ?

If Yes, Company Name :

Designation :

Address :

Which course do you intend to undergo at SEBIZ?

How did you come to know about SEBIZ :

If, Others/Reference Mention :