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Ur name or surname Surname Name Roll No. Merit No. 2. Present address in full (i.e. House No. Lane / Street, Road, Village, Thana, Tehsil, District) Village: District: 3. PIN Home Address in full (i.e. House No. Lane / Street, Road, Village, Thana, Tehsil, District) Village 4. District: PIN Particulars of places where you have resided for more than one year during the preceding five year From To Residential Address in full (i.e. House No. Lane / Street, Road, Village, Thana, Tehsil, Dist.

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