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Basic Details Additional Details

Last Name ( Surname )*

First Name *

Middle Name *

Gender *

Date Of Birth *

Registered Mobile Number(RMN) *

WhatsApp Mobile Number

E-mail ID *

Aadhar Number *

Category *

Parallel Reservation

Permanent Address *

State *

District *

Taluka / Ward *

Place *

Pincode *

Education Details

Class (Status while registering) *

Exam Group *

PCM

PCB

PCMB

Courses *

10th Percentage *

Appearance Status *

Target year of Final Exam * Note: Select Year when you will be giving final NEET / JEE / MHT-CET Exam.

State

District

Taluka / Ward

Name of Institute *

* fields are mandatory

Parent Details

Father's Name

Father's Mobile Number

Father's Occupation

Mother's Name *

Mother's Mobile Number

Mother's Occupation

Number of Brother's/ Sistere's *

First Brother/ Sister Name

First Brother/ Sister Std

Second Brother/ Sister Name

Second Brother/ Sister Std

Parents' Yearly Income *

Other Details

Distance from Pune (In km)

12th Percentage

Details of SSC (10th) / Equivalent Examination Board *

Details of HSC (12th) / Equivalent Examination Board *

Coaching Classes Name and Place

* fields are mandatory

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