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1) Personal Details (Type in Block Letters)
Name
*
Email
*
Gender
*
Male
Female
Birth Place
*
DOB
*
Mobile Number
*
Whatsapp Number
*
Postal Address
*
2) Parent Guardian Name(Type in Block Letters)
Parent's Name
*
Parent's Mobile No.
*
3) Eductional Qualification
Name of School
*
Education Board Name
*
Add Marks obtained (%)
Physics
*
Chemistry
*
Biology
*
English
*
Year of Completion
*
4) Course of Study Applied for
Name of the Course
*
Medium
*
Name of University Applied for
*
5) NEET Score
NEET Score
*
6) UPLOAD REQUIRED FILES
Your 10th Certificate:
Your 12th Marksheet:
Your Passort or Adhaar Card:
7) OPTIONAL FILES
Do you have Passport?
*
Yes
No
Passport Number:
*
Expiry Date:
*
I hereby declare that all the information given by me in this application is true and correct to the best of my knowledge and belief. I also note that if any of the above statements are found to be incorrect or false or any information or particulars have been suppressed or omitted there from, I am liable to be disqualified and my admission may be cancelled. I have read and understood the terms and conditions of the Admission. I hereby permit the consultancy to use, display or transfer any of the details furnished by me in this form for complying with the admission formalities.