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Exam Passed

Name of the Course

Board/University

Percentage

Graduation

Post Graduation

Any Other Qualification

Program Applied For

* Program Name :

Personal Detail

* Name Mr./Ms.:

* Date of Birth : (mm/dd/yyyy)

* Gender:

Marital Status:

Nationality:

Category:

Contact Details

* Correspondence Address :

* Phone No:

Mobile No:

e-mail:

Permanent Address :

Phone No:

Mobile No:

Detail of Local Guardian :

Family Detail

* Mother's Name:

Occupation:

Contact No.:

* Father's Name:

Occupation:

Contact No.:

Educational Qualifications

Awards and Achievements:

Employment History

Any work experience:

Total Experience:

Organization Detail

Name of Comp.	Address	Duration	Designation	Nature of Work	Salary Drawn

Family in JaganNath Gupta Memorial Educational Society(JNGMES)

Have any of your family member studied/ working with JNGMES:

If Studied

Name:

Program:

Year:

If Working:

Name:

Department:

Relation:

Where did you come to know about the University and Programes

Name of Qualifying written test	Examination Date	Roll No	Score

Payment Details

Demand Draft No:	Date:	Name Of The Bank:	Amount:

Current Date:

Enclosures Check-list

   1. 3 Passport size Photograph
   2. Mark sheet of 10^th
   3. Mark sheet of 12^th
   4. Graduation Degree and Mark sheets (if Applicable)
   5. Post Graduation Degree and Mark sheets (if Applicable)
   6. Character Certificate
   7. Extra-curricular activity Certificate (if Applicable)
   8. Results of Qualifying written test

Declaration

I here by certify that the information given in the Application/Registration form is complete and accurate to the best of my knowledge. I understand and agree that misrepresentation or omission of facts will justify the denial of admission, cancellation of admission or expulsion.