- Smt. Parmeshwaridevi Durgadutt Tibrewala Lions Juhu, College of Arts, Commerce & Science J. B. Nagar

REGISTRATION APPLICATION FORM FOR COURSE

1. Registration Details* (Mandatory fields)

Course Admitted *

Type of Student

Aided Un-Aided

ERN/PRN No. *

Student's Surname*

Student's First Name*

Student's Father Name*

Mother's Name *

( Full Name As Per Educational/Legal Certificate )

Gender *

Date of Birth(dd-Mon-yyyy) *

( As per high school certificate in 'dd-Mon-yyyy' format. i.e. '01-Jan-1990' )

Category *

Religion *

Caste *:

Blood Group

Place of Birth *:

Apply for Concession *

Minority Status *:

Citizen *

2. Contact Details *

Mobile No. *

Father Mob.*

Guardian Mob.*:

Email Address *

(e.g.abc@yahoo.com)

3. Address Details

Address Line1 *

Address Line2

Tehsil *

City/Town/Village *

Country *

State *

District *

Pin Code *

4. Educational / Qualification Details

STD 12th Stream

SL.No.	Qualification	Board/University	Seat/Roll Number	Passing Year	Marks	Grade / Percentage
1.	STD 10th *
2.	STD 12th *
SL.No.	Qualification	Board/University	Seat/Roll Number	Result	Month	Year	CGPA
1.	Sem I *
2.	Sem II *
3.	Sem III *
4.	Sem IV *

5. Other Information

Do you wish to join NCC/NSS *

Yes No

If Physically Challenged *

Mother Tongue *:

Occupation of the Grardian *

Annual Income of the Guardion (Rs.) *:

Candidate Aadhar Card No. *

Upload Aadhar Card :

Upload Photo: * Photos should only be in jpg format Photos size should not exceed 50KB
Upload Signature : Signature should only be in jpg format* Signature size should not exceed 50KB

6. Declaration by Student

* I Agree I hereby declare that, I have read the rules related to admission and the information filled in by me in this form is accurate and true to the best my knowledge. I will be responsible for any discrepancy, arising out of the form signed by me and I undertake that, in absence of any document the final admission will not be granted and/or admission will stand cancel.

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