Application Form No (Use Bank Transaction ID as Number)*

Bank Transaction Id*

Admission For The Class*

MAT / UGAT Roll No

MAT / UGAT Composite Score

Name*

Date of Birth*

Sex*
MaleFemale

Father's Name

Mother's Name*

Father's Occupation*

Nationality*

Caste*

Address for Correspondence*

Pin Code*

STD Code*

Telephone No*

Mobile No*

Permanent Address*

Pin Code*

City*

STD Code*

E-Mail Id (Fill your correct E-Mail Id)*

Special Achievements / Awards Received*

Education Qualification : - Course/Board, Institution, Year of Passing, AGGT % *

Working / Not Working(if working please specify company details & designation)*

Refrees / Subjects*

Hostel Required*
YesNo

Bank Loan Required*
YesNo

Date*

Please Upload Scan Copy of the Bank Receipt

Please upload your passport size Current Photo*

Please Upload Scan copy of Class X Board Admit Card*

Please Upload Board Marksheet or Pre Board Marksheet or Pre Class Marksheet*