<html>
<head>
<style>
table{
width: 100%;
border-collapse:collapse;
border: 1px solid black;
}
table td{line-height:25px;padding-left:15px;}
table th{background-color:#363636; color:white;}
 @media print {
 #name2{font-weight:bold;font-size:13px}
 #name3{font-size:13px}

  body{
  -webkit-print-color-adjust:exact;
}
 
 }
</style>

</head>
<body>
<table border="1">
<tr  style="background-color:#363636;color:#ffffff;text-align:center;font-size:24px; font-weight:600;">
<td colspan='4'>Office Copy</td>
</tr>
<tr>
<td>एडमिशन  संख्या :</td>
<td>0123456</td>
<td>कक्षा </td>
<td>Chandra</td>
</tr>
<!-----2 row--->
<tr>
<td>प्रेवशार्थी</td>
<td>x0x0x0</td>
<td>विषय </td>
<td>0x2x6x25x6</td>
</tr>
<!------3 row---->
<tr>
<td>पिता/पति का नाम </td>
<td>23/02/xxxx</td>
<td>जन्मतिथि </td>
<td>0</td>
</tr>
<!------4 row---->
<tr>
<td>दिनांक</td>
<td>26123456</td>
<td>मोबाइल</td>
<td>30</td>
</tr>
<!------5 row---->

</table>
<tr></tr>
<br/>
<table border="1">
<tr>
<th colspan='3' >Subject Select By Candidate</th>


<th>Subject Given by College</th>
</tr>
<tr>
<td rowspan='4'>Sem-1</td>
<td>Major-1</td>
<td></td>
<td> </td>

</tr>
<tr>
<td>Major-2</td>
<td></td>
<td></td>

</tr>
<tr>
<td>Major-3</td>
<td></td>
<td></td>

</tr>
<tr>
<td>Minor</td>
<td></td>
<td></td>

</tr>

</table>

<table border="0" style='margin-top:9px'>
<tr>
<th colspan='4' >Checked by Counselor</th>

</tr>

<tr>
<td><input type='checkbox'> &nbsp; Name</td>
<td><input type='checkbox'> &nbsp; Father Name</td>
<td><input type='checkbox'> &nbsp; Mother Name</td>
<td><input type='checkbox'> &nbsp; Date Of Birth</td>


</tr>
<tr>
<td><input type='checkbox'> &nbsp; Gender</td>
<td><input type='checkbox'> &nbsp; High School Marks</td>
<td><input type='checkbox'> &nbsp; InterMediate Marks</td>
<td><input type='checkbox'> &nbsp; Registration Fee</td>


</tr>

</table>

<table border="0" style='margin-top:9px'>
<tr>
<th colspan='4' >Submit Document by Candidate (Photocopy & Original)</th>

</tr>

<tr>
<td><input type='checkbox'> &nbsp; High School Mark sheet</td>
<td><input type='checkbox'> &nbsp; InterMediate Mark Sheet</td>
<td><input type='checkbox'> &nbsp; Caste Certificate</td>
<td><input type='checkbox'> &nbsp; Domicile Certificate</td>
</tr>
<tr>
<td><input type='checkbox'> &nbsp; Aadhar Card</td>
<td><input type='checkbox'> &nbsp; Transfer Certificate</td>
<td><input type='checkbox'> &nbsp; Character Certificate</td>
<td></td>


</tr>


</table>
<p style='width:100%'>-------------------------------------------------------------------------------------------------------------</p>

<table border="1">
	
	<tr  style="background-color:#363636;color:#ffffff;text-align:center;font-size:24px; font-weight:600;">
<td colspan='4'>Candidate Copy</td>
</tr>
<tr>
<td>एडमिशन  संख्या :</td>
<td>0123456</td>
<td>कक्षा </td>
<td>Chandra</td>
</tr>
<!-----2 row--->
<tr>
<td>प्रेवशार्थी</td>
<td>x0x0x0</td>
<td>विषय </td>
<td>0x2x6x25x6</td>
</tr>
<!------3 row---->
<tr>
<td>पिता/पति का नाम </td>
<td>23/02/xxxx</td>
<td>जन्मतिथि </td>
<td>0</td>
</tr>
<!------4 row---->
<tr>
<td>दिनांक</td>
<td>26123456</td>
<td>मोबाइल</td>
<td>30</td>
</tr>
<!------5 row---->

</table>
<tr></tr>
<br/>
<table border="1">
<tr>
<th colspan='3' >Subject Select By Candidate</th>


<th>Subject Allotted by College</th>
</tr>
<tr>
<td rowspan='4'>Sem-1</td>
<td>Major-1</td>
<td></td>
<td> </td>

</tr>
<tr>
<td>Major-2</td>
<td></td>
<td></td>

</tr>
<tr>
<td>Major-3</td>
<td></td>
<td></td>

</tr>
<tr>
<td>Minor</td>
<td></td>
<td></td>

</tr>

</table>

<table border="0" style='margin-top:9px'>
<tr>
<th colspan='4' >Checked by Counselor</th>

</tr>

<tr>
<td><input type='checkbox'> &nbsp; Name</td>
<td><input type='checkbox'> &nbsp; Father Name</td>
<td><input type='checkbox'> &nbsp; Mother Name</td>
<td><input type='checkbox'> &nbsp; Date Of Birth</td>


</tr>
<tr>
<td><input type='checkbox'> &nbsp; Gender</td>
<td><input type='checkbox'> &nbsp; High School Marks</td>
<td><input type='checkbox'> &nbsp; InterMediate Marks</td>
<td><input type='checkbox'> &nbsp; Registration Fee</td>


</tr>

</table>

<table border="0" style='margin-top:9px'>
<tr>
<th colspan='4' >Submit Document by Candidate (Photocopy & Original)</th>

</tr>

<tr>
<td><input type='checkbox'> &nbsp; High School Mark sheet</td>
<td><input type='checkbox'> &nbsp; InterMediate Mark Sheet</td>
<td><input type='checkbox'> &nbsp; Caste Certificate</td>
<td><input type='checkbox'> &nbsp; Domicile Certificate</td>
</tr>
<tr>
<td><input type='checkbox'> &nbsp; Aadhar Card</td>
<td><input type='checkbox'> &nbsp; Transfer Certificate</td>
<td><input type='checkbox'> &nbsp; Character Certificate</td>
<td></td>


</tr>


</table>
<table   style="border:none; border-collapse:collapse; cellspacing:0; cellpadding:0;margin-top:40px" >
	<tr>
<td width='50%'>  &nbsp; Counseling Date</td>
<td style='text-align:right'> Verifier/Counselor Sign</td>



</tr>
	</table>
</body>
</html>