College And Course Details
Course Type*	--Select-- UG PG	District*	Neemuch Ujjain Dewas Ratlam Shajapur Mandsaur -Please Select-
College Name*
Program Name*		Branch*	-Please Select-
Admission Type*	-Please Select- Private	Medium*	-Please Select- ENGLISH HINDI URDU

Personal Details
First Name*		Last Name*
Name in Hindi*
DOB*		Gender*	-SELECT- Male Female
Father's Name*		Mother's Name*
Marital Status*	MARRIED UNMARRIED WIDOW SELECT	Husband's Name
Category*	-SELECT- UR OBC SC ST	Sub-Category	Minority   Handicapped
Nationality*	-SELECT- INDIAN OTHER	Religion*	-SELECT- HINDU MUSLIM SIKH CHRISTIAN JAIN BUDDHIST PARSI OTHER

Address
Correspondance House No/ Village Colony/ Post City/ Tehsil* State* District Pincode Copy to Permanent Address	Permanent House No/ Village Colony/ Post City/ Tehsil State District Pincode

Other Details
Phone Number(With STD Code)				Mobile Number*
Email Id*

Previous Education Details
Exam Passed/Appeared:*
University/Board*		Enter Board/ Univ. Name*   Enter Previous enroll. No*
Passed/Appeared Year:*	1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 -Please Select-	Percentage*	.  %
Eligibility/Migration/Transfer Certificate No.*		Vikram Univ Previous Roll No(For Ex)

Bank A/C Detail Bank A/C No Enclosures Eligibility certificate? Migration certificate? Proof for DOB? Marksheet? Gap Certificate? Declaration I hereby declare that the information filled by me is true and complete as per my knowledge. If any information provided by me is found false or incorrect then i shall be disqualified by the university. If You passing 12th Exam after 2019 So Canceled Your All Related submitted forms.

Photo & Signature* Upload Image