Registration Form For Admission
(Session - 2018-19)
Fields marked with * are mandatory
University*
College *
Course Details
Course *
Branch *

Group *

Year *
Branch Mode*
Personal Details
Higher Education ID
Name of Student *




Name of Father *
Mention NA if not applicable

Name of Mother *
Mention NA if not applicable

Date of Birth (DD/MM/YYYY) *
Birth Place *
Gender*
Religion *
Aadhar Card Number
Samagra ID
Blood Group *
Category *
Nationality *
Father's Profession
Father's Annual Income
Contact Details
Email ID @
Contact Number *
Emergency Contact Number *
Address *
Pin Code *
State *
District *

Local Guardian's Name
Local Guardian's Phone No
Local Guardian's Address
Pin Code
State Madhya Pradesh District Jabalpur
Academic Details
Examination Details
If the Result is not declared, Please enter 00 in Obtained and Total Marks.
Medium *
University Enrolment/Registration No.
(Applicable only for PG)
Migration Certificate Number Any Extra Curricular Activities

Upload Photograph with Signature*