Registration Form

Full Name:
Date of Birth :
Email Id:
Mobile Number:
Phone Number:
Upload Photo (max-2mb, file type .pdf|.jpg|.doc):
Upload Signature (max-2mb, file type .pdf|.jpg|.doc):
Mailing Address:
State :
Pincode:

Course details
Center:
Course:
Stream:
Session:

IDENTITY PROOF DETAILS

ORIGINAL PROOF ARE REQUIRED AT THE TIME OF ADMISSION CONFIRMATION

Proof: PassportElection ICardDriving LicenseCollege ICardPan CardOthers
Upload Proof (max-2mb, file type .pdf|.jpg|.doc):
Name of Card Holder :
Card No.:

FATHER'S/GUARDIAN'S DETAIL
Name:
Occupation:
Phone No:

DEGREE DETAILS
Qualification:
Name of College & City :
Year of Passing/Expected:
% Degree Marks:

PAYMENT MODE
Payment Mode: Cash Deposit in BankOnline Money Transfer in Bank
Upload Proof of Cash Deposit or Online Money Transfer (max-2mb, file type .pdf|.jpg|.doc) :

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