Application Form

*Note : After filling the form and application fees please send your confirmation details in [email protected] or whatsapp in 7720094513

    STUDENT DETAILS
    First Name *
    Middle Name *
    Last Name *
    Date of Birth *
    Email Address *
    Mobile Number *
    Alt. Mobile Number
    Course Name *
    Marks Scored In 10th (% only)*
    Marks Scored In 12th (% only)*
    FATHER DETAILS / GUARDIAN DETAILS
    Father Name
    Father Mobile Number
    Father Occupation
    Annual Income Upto *
    Upto 3 LacUpto 5 LacUpto 10 LacMore Than 10 Lac
    YOUR ADDRESS

    Permanent Address:

    Current Address:

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