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I hereby declare that the above information given is true & correct. I will be held liable for any wrong
information given which shall include cancellation of scholarship, recovery of amounts paid already if any
besides criminal action.
Name & Signature of the Student Name & Signature of the Parent
EPASS Application ID (2015-16):____________ Address: H.No.:____________
Course: ________ Course Year:_ Village & Mandal:___________
College: _______________________________ City & District: _____________
College District:______________ Mobile No:_________
Mobile No:__________