etlab | UG Student Registration for Academic Year 2023

Style:

Personal Details

First Name *

Middle Name

Last Name

Gender *

Blood Group

Date of Birth *

Mother Tongue

Place of Birth

Nationality

Religion *

Caste *

Eligible Reservation Category

PWBD (Person With Benchmark Disability)

APL/BPL

Economically Weaker Section(EWS)

Aadhar No *

Economicaly Backward

Admission Details

Admission for *

Academic Year *

Program Opted *

Type

Nativity

Qualification

Higher Secondary School Details

Board

Year

Reg No

HSE Stream Studied

Higher Secondary Percentage Obtained

Subject 1

Obtained Mark

Percentage

Subject 2

Obtained Mark

Percentage

Subject 3

Obtained Mark

Percentage

Subject 4

Obtained Mark

Percentage

Subject 5

Obtained Mark

Percentage

Subject 6

Obtained Mark

Percentage

Total Mark

Overall (%)

Secondary School Details

Board

Year

Reg No

TC Details

Last Institute (As per TC)

TC No

TC Date

Contact Details

Present Address

House Name *

Street *

Post / Street 2 *

District *

Pin *

State *

Permanent Address [ same as present address ]

House Name *

Street *

Post / Street 2 *

District *

Pin *

State *

Student Phone No *

Email *

Land Phone

Personal Marks for identification

Personal Marks 1

Personal Marks 2

Bank Details

Name of Bank

Account No

Name of Branch

IFSC Code

Hostel Facilities (Only for girls)

Do you need Hostel Facilities

NoYes

Medical Fitness Details

Name of Doctor

Date

Extra Curricular Activities

Arts

Sports

Parent Details

Father's Name *

Mother's Name *

Father's Occupation

Mother's Occupation

Father's \ Guardian's Mobile No *

Mother's Mobile No

Parent Email

Phone Office

Select Guardian

Annual Income

Name of Guardian

Relationship with the student

Address of Guardian

Guardian's No

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Parent Signature

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+2 Certificate

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