PLEASE FILL APPLICATION IN CAPITAL LETTERS ONLY

Student Name

Date of Birth

Father Name

Mother Name

Family Income

Mobile Number

Address

UG Qualification

Course Name	Speciality	College Name	Univ./Board	Year of Passing	%age Marks

PG Qualification

Course Name	Speciality	College Name	Univ./Board	Year of Passing	%age Marks

Other Qualification(if any)

Course Name	Speciality	College Name	Univ./Board	Year of Passing	%age Marks

Email address

Gender Please Select Gender Male Female Transgender Others

Category Please Select Category Gen SC BC OBC HC Others

Note: User can make One (6000 rupees) DD/NEFT/Online For both examination and propectus payments and same DD/NEFT/Online information can be filled in both payments details. Total Amount is 6000

Prospectus Payment Details

Mode of Payment	Name of Bank	Online/DD/NEFT No.	Online/DD/NEFT DATE	Amount
Please Select Payment Mode DD NEFT Online Others				3000

Examination Payment Details

Mode of Payment	Name of Bank	Online/DD/NEFT No.	Online/DD/NEFT DATE	Amount
Please Select Payment Mode DD NEFT Online Others				3000

Upload Photo (Size should be less then 50kb, only .jpg,.jpeg,.png files are accepted)

Upload Signature (Size should be less then 50kb, only .jpg,.jpeg,.png files are accepted)

Upload Thumb impression (Size should be less then 50kb, only .jpg,.jpeg,.png files are accepted)