Student Registration Form

To
The Controller of Examination.
AIIMS, Patna.

Student Information
Course Name  
Form No Enter Form No. To Proceed      Session   
Enrollment No To Be Filled By Officials   Admission Date    
Roll No      Rank   


First Name Strictly as per Class XII or GAZETTE Notification    Middle Name
Last Name Strictly as per Class XII or GAZETTE Notification    Date of Birth   DOB Auto Calculated on Age (Vice Versa)     Category    
Gender    Nationality   
Religion Email ID   
Mark Identification Fathers Name   
Mothers Name     
Correspondence Address
State   District  
Town/Village    Police Station   Pin       
Landline No Mobile No   
Street Address    
Permanent Address    Same as above
State   District  
Town/Village    Police Station   Pin       
Landline No Mobile No   
Street Address    
Emergency/Local Guardian Contact
Guardian First Name    Guardian Last Name   
Guardian Mobile No    Relationship Type   Pin       
Guardian Address    
Qualification
School/College Name State City % of Marks Division Pass Year Board
             
Sl.School/College NameStateCity% of MarksDivisionPass YearBoard