Name of Student*:

Date of Birth (DD-MM-YYYY):

Gender:

Name of Parent /Guardian:

Occupation:

Religion:

Caste:

DD No:

Address:

Pin:

Tel:

Mobile*:

Email*:

Details of Marks obtained in Plus 2

Scheme/Syllabus whichever is applicable:

Name of School:

Marks obtained in Physics:

Marks obtained in Chemistry:

Marks obtained in Maths:

Total PCM marks:

Total PCM %:

Common Entrance Exam Rollno:

Rank:

Branch to which the student wishes to join

1st Choice:

2nd Choice:

3rd Choice:

  I,   declare that the above said information are correct to the best of my knowledge.