Direct Admission

Medium

Study Center

Name

Father's Name

Mother's Name(Optional)

Date of Birth

Parent's Permanent Residence Address Note:(Do not write your/your Father's Name)

Gender

Category

City/Town/Village

Pin Code

Country Id

State

District

Mobile No.(Self)

Mobile No.(Father)

Mobile No.(Mother)(Optional)

Email (Self)

Photo(Optional) Image should be "jpg" only , and image size should be less then 200KB

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