Name of the Applicant* :
Date of Birth* (dd/mm/yyyy) :
Enrollment Number*
(Enter either your Enrollment Number OR Mobile Number Only)
:
Course Studying* :
Institute/Faculty/Unit* :
Department* :
Whether Hostelar* :
Course Completion Date* (dd/mm/yyyy) :
Whether Research Scholar* :
Specify Old Login Id (If Any) :
Mobile Number* :
Nationality* :
Email ID* :
Your "Login-USERNAME" for Proxy will be generated automatically after submitting this form
Enter Password*
(Kindly notedown the password for future use)
:
Re-Enter Password* :