Baluni Classes

Dehradun: C-7, Nehru Colony, Near LIC Building, Haridwar Road, Ph: 9690000899
Braches: Kotdwar, Haridwar
Corp. Off: 30 Bhagya Nagar Agra-Mathura Bypass, Near Amar Ujala Press Agra Ph : 9837919228

Form No.

Application For Course :	Medical:	Engineering:
Exam Center First Choice
Dehradun:	Haridwar:	Vikasnagar:	Kotdwar:	Srinagar:	Roorkee:	Uttarkashi:
Exam Center Second Choice
Dehradun:	Haridwar:	Vikasnagar:	Kotdwar:	Srinagar:	Roorkee:	Uttarkashi:

1. NAME IN FULL :
2. FATHER'S /GUARDIAN'S NAME:	3. MOTHER'S NAME :
4.PARENT'S / GUARDIAN'S OCCUPATION :	5. ANNUAL INCOME :
6. DATE OF BIRTH :	7. GENDER :
8. CATEGORY :	9. SUB CATEGORY: :
10. PERMANENT ADDRESS (do not write father's / gardian's name here) :
11. CITY :	12. PIN NO :
13. PHONE NO :	14. MOBILE NO :
15. E-MAIL :
16. NAME OF THE SCHOOL (from where appeared / appearing for class X / XI / XII) :
17. PERCENTAGE OF MARKS OBTAINED IN CLASS X :

Maths : 0.00 %

Science : 0.00 %

Aggregate : 0.00 %

18.PERCENTAGE OF MARKS OBTAINED IN CLASS XII :

Physics : 0.00 %

Chemistry : 0.00 %

Maths : 0.00 %

Biology : 0.00 %

Aggregate : 0.00 %

19.Fees Details :

Amount :

Mode Of Payment :

DD No.:

Name Of Deposit Bank :

Deposit Date :

NOTE: The 100% scholarship will be provided to 50 successful and eligible candidates, after taking admission in Baluni Classes.

Entrance Fees:- Rs. 500/- (for All Candidates) Candidates as entrance examination fee. If downloaded from the website, demand Draft for entrance fee in favour of "Baluni Welfare & Educational Society" payable at Dehradun should be included along with the application form.

DECLARATION : I hereby declare that the information furnished by me are correct and true to the best of my knowledge and belief and nothing has been concealed. In the event of any information found incorrect or misleading, my candidature shall be liable to cancellation by Baluni Classes at any time.