Note: Please read the form carefully before filling it.
          Attach the required documents as mentioned in educational qualification.
          Result/Score of qualifying examination.
          Incomplete application will be rejected.
Form No.
Registration No.
(to be given by the office)
Programme Applied For : *
Details of the Qualifying examination: *
Name of Qualifying Examination Month & Year Score
LSAT-2011 Reg. no.: (Only for Law Student)
Personal Details:
  Name Mr./Ms. * ( eg.Raj Kumar)
Date of Birth : *
(as in the certificate of 10th examination)
Nationality Category
Marital Status Married     Unmarried Gender Male    Female
Contact Details:
Correspondence Address :*
Phone No.: Mobile No.: Mail ID.:*
Permanent Address :*
Phone No.: Mobile No.:
Detail of Local Guardian :
Name: Phone/Mobile No. :
Address :
Family Details:*
Parent's Name Occupation Phone No. Mobile No. Mail ID
Educational Qualifications:*
Examination Passed Name of The Stream Name of the School/College and Board/University Year of Passing Subject Studied Marks Obtained Maximum Marks % of Marks
Awards and Achievements (if any) :
Participation in Extracurricular Activities :
Employment History :
Work Experience:   Yes       No      (If, Yes) Total Experience : Years  
Organization / Company Detail :
Name of Company Address Duration Designation Nature of Work Salary Drawn
Payment Details :
DD No. DD Date Amount Name & Address of Bank

I hereby certify that the information given in the Application is complete and accurate to the best of my knowledge. I understand and agree that misrepresentation or omission of facts will justify the denial of admission, cancellation of admission or expulsion.
Date (mm/dd/yyyy) *


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