Registration Form

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Registration

Student Registration Form

1. Applicant's Name In Full(BlOCK LETTER):Mr./Ms./Mrs.

First Name :

Middle Name :

Last Name :

Father's/Guardian's
Name:

Mother's Name :

Income par Annum :

Date of Birth :

Gender :

Male

Female

Marital Status :

Unmarried

Married

Category :

Cast :

Religion :

Nationality :

8. Correspondence Address

Address :

City .:

Pin No .:

District :

State :

Phone No. :

Mobile No. :

Email :

9. Permanent Address

Student Address :

City .:

Student Pin No. :

District :

State :

Student Phone No. :

Student Mobile No. :

Student Email :

Password :

10.

Gradient Status :

Yes

Name :

Occupation :

Student Corresspondence :

place Of Birth :

Mother Tongue :

Where to Reside :

Test Thalassemia ? :

Yes

Father's Annual Income :

Blood Group :

Are You Employed? : Yes No

Deputation Status : Yes No

11. Upload Photograph & Signature :

Upload Photo :

Upload Signature :

(Valid Format: .JPG, .JPEG, .PNG, .BMP)

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