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Enquiry

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Name of the Applicant*

Father / Mother Name*

Educational Qualification

Education Board
 State Board / Matric CBSE Others

Percentage of Mark(10th / Diploma)

Percentage of Mark(12th / UG)

Name of the Institution
 Easwari SRMU TRP Dental

Mode of Admission
 Regular Lateral Entry

Name of the Course / branch Required*

Other Course Details

Contact Address*

State*

Contact Number*

Landline