초소형 시스템 인 패키지 모듈 개발

1. Name in full (in block letters) ---------------------------------------------------------------------------2. Father’s/Husband’s name -----------------------------------------------------------------------------3. Address : (i) Present address (for correspondence) : -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------E-mail address -------------------------------------------Mobile No. ----------------------------(ii) Permanent home address : -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------4. Date of birth ----------------------------------------------Age ----------------------------------------(According to Matriculation Certificate) (Enclose Copy) (As on 01.07.2013) 5. Are you a bonafide resident of Chhattisgarh Yes/No (If “Yes” please attach a copy of Domicile Certificate) 6. Place of birth (with name of Village/City, District and State) ---------------------------------------------------------------------------------------------------------------------------------------------------7. (a) Mother tongue -------------------------------------------------------------------------------------(b) Other language (s) which the applicant can speak, read and write fluently ------------------------------------------------------------------------------------------------------------------------8. Category (UR-Un Reserved/ SC-Scheduled Caste/ STScheduled Tribe/OBC-Other Backward Classes) ------------------------------------------------------------------------------------------------------------------(if belong to SC/ST/OBC Category, please enclose a certificate from competent authority) (Details of application fee) D.D. No. ------------------------------Amount --------------------------------Date ------------------------------------Affix Latest coloured Passport size photograph