Telangana OBMMS

Name:*

Date of Birth:*

Age (18 - 27):*

Education Qualification:*

Gender:*

Male Female

Father's Name:*

Father's Occupation:*

Mother's Name:*

Phone Number:*

Email Address:*

UID (Aadhar) Number:*

House Number:*

District:*

Mandal:*

Panchayat/Village:*

BC Group:*

Sub Caste(Certificate should be enclosed):*

Disability Status(Certificate should be enclosed):*

Yes No

What is your family's Annual income(Certificate should be enclosed)?:*

SSC Year of Passing:*

SSC Percentage(Certificate should be enclosed):*

Bachelor's Degree Year of Passing:*

Bachelor's Degree Percentage(Certificate should be enclosed):*

Do you have Qualification higher than a Bachelor's Degree?:*

Yes No

Are You Currently Employed?*

Yes No

Current Residence(Hostel,Home,PG):*

Do You own a laptop or desktop:*

Yes No

Are you Willing to attend 5-day training?*

Yes No

Do You need special support(hostel,travel, etc.,)?*

Uploads: (Please Upload JPG/JPEG/PDF/PNG file size below 2MB)

Annual Income Certificate:*

Caste Certificate:*

SSC Certificate:*

Degree Certificate:*

TELANGANA
ONLINE BENEFICIARY MANAGEMENT &
MONITORING SYSTEM (OBMMS)