SAMEEKSHA : Registration Form

Personal Information

Your Name Required

Father's Name Required

Mother's Name Required

Date of Birth

Gender Required

Category Required

Medium Required

Email Required Invalid

Address Required

City/Town/Village Required

Pin Code Required

State Required

District Required

Mobile No. (Self) Required Invalid

WhatsApp No. Invalid

Mobile No. (Father) Invalid

Mobile No. (Mother) Invalid

Class Required

Photograph (Upload)

Academic Information

Target Required

Test Date Required

	Max. Marks	Marks Obtained	%	CGPA (If CGPA was given)
% in Class X
% in Class XII (For XII Pass Students)

Performance in Comp. Exams(If Appeared before) Required

Performance Details

SAMEEKSHA : Registration Form Student