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Note:
The details given in the registration form should be same as in the enrollment form
Personal Details
Name of the student
Date of Birth
Day
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Month
January
February
March
April
May
June
July
August
September
October
November
December
Year
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
Gender
Male
Female
Name of Parent /Guardian
Contact Information
Phone No.
STD
NO.
Mobile No.
Address 1
Address 2
Address 3
Address 4
Student's E-mail
Email of Parent/ Guardian
City / District
State / Territory
(Indian states)
[Select State]
[Outside India]
Andaman and Nicobar Islands
Andhra Pradesh
Arunachal Pradesh
Assam
Bihar
Chandigarh
Chattisgarh
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Goa
Gujarat
Haryana
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Jammu and Kashmir
Jharkhand
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Lakshadweep
Madhya Pradesh
Maharashtra
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Others (Please specify)
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Virgin Islands (British)
Virgin Islands (US)
Wallis And Futuna Islands
Yemen
Yugoslavia
Zambia
Zimbabwe
Pin Code/Postal Code
Postal Course
Classroom Course
Admit Exam Fees
Course Fees
Note:
Please enter the
Fees and Center
, where you are going to take the exam.
Exam Fees
(INR)
Center
Note:
Please enter the
Course Name and Fees
as per the letter received from our centre
Course Name
Fees
(INR)
Education Details
Student's Qualification
8th
9th
10th
11th
12th
First Year
Second Year
UG ARTS/SCIENCE FINAL
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PG-FINAL
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CBSE SKOOL PREP - Board Exams (Class VIII to XII)
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Target:MBBS 2009
Target:MBBS 2010
CBSE SKOOL PREP - Board Exams (Class VIII to XII)
IIT - Postal
Target:IIT 2009
Target:IIT 2010
MBBS - Postal
Target:MBBS 2009
Target:MBBS 2010
Checking
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CBSE SKOOL PREP - Board Exams (Class VIII to XII)
IIT - Postal
IIT:ELITE
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AIEEE-BITSAT
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CBSE-PLUS
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B.MAT SERIES
IIT-JEE-AIEEE COMBO TEST SERIES
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