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Student's Name *

Gender *

Mobile No *Mobile No* (*Students must provide a mobile number during admission, which cannot be changed until the course ends.)

Email Address *Email Id* (*Students must provide a valid Email Id during admission, which cannot be changed until the course ends.)

Aadhaar No *

First Semester Date of Admission *

ABC ID *

College Roll No. *

University Registration No. *

University Roll No. *

Father Name *

Mother Name *

Vill/Street *

Post Office *

Police Station (P.S.) *

Block *

Pin No *