Kori Samaj

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Full Name Of Candidate *

Full Name Of Father/Husband*

Full Name Of Mother's *

Gender*

Male Female

Addres*

Email*

Date Of Birth *

Mobile No*

Exam Name	Year	Organisation	Position	Marks	Obtain Marks	Percentage
High School
Intermediate
Graduation
Post Graduation
Diploma

Signature Upload*

Photo Upload*

Father's Occupation*

Father's Annual Income*

Cast*

Sub-Cast*

Aadhaar Card NO.