For Student's Use Only

Application Form

Fill out this form to complete your registration process

Reg (#4)

First Name

Middle Name

Last Name

Father's Name

Mother's Name

D.O.B

Place of Birth

Nationality

Gender

Male

Female

Physical Disability

Yes

No

Caste

Residential Address

Address Line 1

Address Line 2

City

State

Pin Code

Country

Tele. Number (Parent's)

Correspondence Address

Address Line 1

Address Line 2

City

State

Pin Code

Country

Mobile Number

Last Exam Passed

Name of Board

Total Marks / Percentage

Remarks

I do hereby declare that all the information given above is true to the best of my knowledge and belief.

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