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Application For Free Laptop Distribution
Name Of The Student
Father's/Spouse Name
Permanent Address
Present address same as permanent address....
Present Address
District
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ANGUL
BALESHWAR
BARGARH
BHADRAK
BOLANGIR
BOUDH
CUTTACK
DEOGARH
DHENKANAL
GAJAPATI
GANJAM
JAGATSINGHAPUR
JAJPUR
JHARSUGUDA
KALAHANDI
KANDHAMAL
KENDRAPARA
KENDUJHAR
KHORDHA
KORAPUT
MALKANGIRI
MAYURBHANJ
NABARANGAPUR
NAYAGARH
NUAPADA
PURI
RAYAGADA
SAMBALPUR
SONEPUR
SUNDARGARH
Aadhar No
Photo
Upload Image
Upload Aadhar Scan Copy
DOB
AGE
Gender
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Male
Female
Other
Mobile No
Name Of The Institution
Name Of The Course
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Bachelor
Master
Phd
Other
Year Of Study
UDID Certificate Number
Disability Type
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Low Vision
Blindness
Disability Percentage
Upload Disability Certificate
Whether Free Laptop Received Earlier ?
Yes
No
Undertaking
I declare that the above information(S) are true and correct to the best of my knowledge.
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