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Exam Form June 2017 (* Fields in Blue Colour are mandatory)
Note : This Exam Form will be available till the last date of Exam Form Submission. Please Fill in the Exam Form carefully. Once it is submitted for a candidate, it can not be submitted again or changed for that candidate. It can only be changed by written request and paying Fee for alteration in Exam Form till the stipulated Date , Are as Below
  Name*
:
       
 
Membership No.*
:
       
  Course* :
  Stream* :
       
  Centre
:
  Subcentre  
  Please enter your details :    
       
  Address*
(If you want to get your Admit Card / Gradesheet on other address than shown here, then please change this address in each line, and City & PIN in the below fields.)
:

       
  City* :
       
  PIN* :
       
  Landline Phone Number*
(with STD code)
:
       
  Mobile Phone Number* :
       
  E-Mail Id* :
       
  Subjects*
(For Project / Seminar / Lab, select here and deposit the Fee at respective Centre)
: Subject1:
Subject 2:
Subject 3:
Subject 4:
Subject5:
Subject 6:
Subject 7:
Subject 8:
Subject 9:
Subject 10:
Subject 11:
Subject 12:
Subject 13:
Subject 14:
Subject 15:
Subject 16:
       
  Examination Centre - Choose your registered centre OR nearest centre only*    
 
  • Centre Choice*
:
 
  • Not Available
:
       
  Coaching Classes attended* :     
       
  Examination Fee* :  
         
  Late Fee* :  
     
  Details of Bank Draft / Online Payment* :  
         
  Bank's MICR Code
(printed on the Draft next to Draft number)
:  
         
  Bank Draft Number/Transaction ID*
(printed on the Draft)

OR Transaction Id
(if Online Payment)
:  
         
  Date(DD-MM-YYYY) of Bank Draft*
OR Online Payment
:  
         
  Amount* : Rs  
         
  Name of Bank*
(also for online payment)
:  
     
 
         
  Declaration by the Candidate : I hereby affirm that the particulars filled by me are true and correct. I also certify that I am eligible for the subjects I have applied for. I have read and understood the Terms and Conditions of the Test and agree to abide by those. I agree to abide by the examination regulations as they exist at present or may be amended from time to time and certify that the information given in the form is correct in all respects.
         
         
       
         

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