REGISTRATION FORM

 

Please read the instruction carefully before you start filling the form

  
     
  Use Block Letters Only

 Don't use special characters like ', ;, > etc..

  
  Qualifying Exam  
  Mark  
  Out of  
  GROUP CHOSEN:    
1st Choice*
   
  2nd Choice*  
  3rd Choice*#  
  Name of the Candidate  
  Date of Birth  (dd/mm/yyyy) Pick a date  
  Blood Group #  
  Sex  
  Caste  
  Religion  
  Mother Tongue  
  Nationality  
  Name of the Institution last attended  
  Name of qualifying Exam  
  Reg.No. #  
  Year  
  Annual Income of the family  
       
  Communication Details    
  Permanent Address with Pin Code    
 

 
   
   
  Present Address with Pin Code#    
 

 
   
   
   
       
  Mobile No  
  Land Line No. with STD Code#  
  Office No.#  
  E-mail  
  Father's Name  
  Occupation  
  Phone No  
  Mother's Name  
  Occupation  
  Phone No  
  Name of the Local Guardian  #  
  Address with Pin Code & Mobile No.    
 

 
   
   
   
   
  Academic Details    
  Marks    
  SUBJECT OBT. MARKS  % OF MARKS  
  ENGLISH  
  SCIENCE  
  MATHS  
  SOCIAL SCIENCE  
       
  Fee Details    
  Mode of Fee Payment    
       
  I undertake to state that the information furnished here in above  
  are true to the best of my knowledge.  
    Agree  
  Date: Pick a date  
  Place:  
  Entrance Examination Date*