BSMS Enquiry Form : (2019-2020)

BSMS Enquiry Form : (2019-2020)
   Fields marked * are mandatory.
Date: : 06-12-2019
Student Name* :
Gender* :       Age* :       Date of Birth* :
Religion* :   Caste/Community* :
Nationality* :
Name of Father/Mother/Guardian* :
Occupation & Annual Income
of Father/Mother*
:
Address for Correspondence* :
Mobile No* :   Land Line
Address for Local Guardian :
Mobile No :   Land Line
Permanent Address :
Mobile No :   Land Line
NEET Roll No* :   Score* :    Rank No* :
KEAM Roll No :   Score  :    Rank No   :
Qualification* :
Name of Exam* :
Year of Passing* :
Name of the Institution* :
Name of the University/Board* :
Percentage of Marks Obtained* : PCB % : %   Biology % : %
Reference Name :    Mobile No :
Reference Address :
   

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