Student ID

First Name*

Middle Name*

Last Name*

P.Name*

Mother Name

country Select Africa India England Other (Please Specify)

State Select Bihar up Maharashtra Other (Please Specify)

City Select Amravati Nagpur Pune Other (Please Specify)

Address

Residential address

Permanent address

Pin code

Caste Category Select OBC OPEN SC Other (Please Specify)

Blood Group Select A+ve B+ve O+ve Other (Please Specify)

Gender* Male Female

DOB

Age

Mobile 1*

Mobile 2

Email

Class* Select 1st 2nd 3rd Other (Please Specify)

Divison* Select A B C Other (Please Specify)

Highest Qualification* Select BE Bsc B.com Other (Please Specify)

Adhar Card No

Voting Card No

BPL Card No

Scheme* Select Private

Course Name* Select

Status Select Pending

Isprovisional* Select Yes No Other (Please Specify)

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