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Application Form

1. Academic Information

Institute *

Course*

Stream *

Year*

2. Personal Information

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Student Name *

E-mail Address *

Date of Birth

Mobile *

Gender *

Nationality *

Religion *

Caste *

Pin Code

Country

Domicile State *

District *

Permanent Address *

3.PARENT'S/GUARDIAN'S INFORMATION

Father's Name *

Father's Occupation *

Mother's Name *

Mother's Occupation *

Mobile *

Local Guardian's Name

Guardian's Mobile

4. ACADEMIC RECORD

Course	Year	Roll No	Board/University	Max. Marks	Obt. Marks	Result	Percentage
High School
Intermediate

Rajat

DECLARATION/UNDERTAKING

I shall scurpulously abide by the Institute Standing Orders and do everything in my power to enhance the reputation and honour of the institute and the profession for which i am commencing my studies. I shall not commit any dishonourable act. I shall not take part in any subversive activities. I understand that ragging is a crime and would never encourage and partcipate in ragging.

I hereby state that all information, given by me, in this application form is correct. In case any information, given by me, is found incorrect, my candidature is liable to get cancelled. In submitting this application form, I accept all the admission rules of .

I declare that i have not taken admission in any institute after passing H.S. or equivalent exam.

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Signature of Applicant * (Width 150- 400px Height 50-100px)

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