Student Details

First Name * :

Last Name :

Email Address Enter valid Email address that is registered with Gmail/Yahoo/Rediff etc.

* :

DOB * : Select date of birth from Calender. The date of birth format should be 'dd mmm yyyy' ex: 15 Jul 2001. Date of birth should not exceed the age configured in settings.

Aadhaar Number :

Mobile Number * :

Gender * :

Mother Tongue :

Male

Female

Nationality * :

Religion * :

Caste * :

Blood Group

Place of Birth

Identification Marks

Admission Details

Admission Year : *

Admission Into (class) * :

Application Details

Application No. * :

Date * : Select date when enquiry received

Previous Institution details

Institution Name :

Address :

Class :

Board/University Enter Board name which the student has studied before joining your Institution. Ex: ICSE,SSC,CBSE,NCERT ect.,

Total Marks :

Percentage Enter percentage of the student of his previous schooling last examination.Percentage should be 12.00 or 100.00 or 99.99

Grade :

Reason for Leaving :

Application Amount : 500 /-(Rs.) *

Mode of Payment * :

Agree the terms and conditions

Address for Communication

Present Address
Address : *

City : *

Country : *

State : *

PIN Code : *

Residential Contact Number : *

Office Contact Number

Same with Permanent Address

Permanent Address

Address :

City :

Country :

State :

PIN Code :

Residential Contact Number :

Office Contact Number :

Father and Mother or Guardian Details

Father

Name : *

Relationship :

Sex :

Male

Female

Qualification :

Occupation :

Email Address Enter valid Email address that is registered with Gmail/Yahoo/Rediff etc.,

Contact Number Enter contact number which is landline connection with STD code ex: 040-6550559

Mobile Number : *

Mother

Name :

Relationship :

Sex :

Male

Female

Qualification :

Occupation :

Email Address :

Contact Number :

Mobile Number

Terms & Conditions

Cancellation & refund Policy

If surcharge module

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