NOTE : * fields are Mandatory..!

PERSONAL DETAILS

Name of the Student *

Father/Guardian's Name *

Gender *

Male

Female

Community *

Quota *

Date Of Birth *

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Age :

Father/Guardian's Occupation *

Mobile No. *

Email-ID *

Address *

State *

City *

Pincode *

EDUCATIONAL DETAILS

10TH STANDARD (Marks Obtained):
Reg No.		Month & Year of Passing
Board		Medium
Name of the School		Place of the School
Total Marks
Maths		Science
12TH STANDARD (Expected Marks):
Month & Year of Passing		Board
Medium		Name of the School
Place of the School		Total Marks
Maths		Biology
Physics		Chemistry
HSC Cutoff


I do hereby declare that above particulars of information and facts stated are true, correct and complete to the best of my knowledge and belief *

Phone: 04256-247000

www.kia.ac.in

Email: [email protected]