BE

ONLINE STUDENT INFORMATION / IDENTITY CARD

COURSE INFORMATION:

Course Name : IYR - BE - BRANCH:_____________ Admission Type : Convener / Management (Tick)

: Intermediate ___________________ / CBSE _______________________

Certificate No

Medium: English

STUDENT INFORMATION
Permanent HT.No.

: _______________________________

Name of the Student

(As per qualifying exam)

(Example : 1602- 13- 736- 001) & Class Roll No :___________________

: ________________________________
Gender : Male / Female (Tick)

Father Name
(As per qualifying exam)

: ________________________________

Blood Group

:_________________________________

Date of Birth

:_________________________________

(Example : Date / Month /Year)

Date of Join in the college :_________________________________

(Example : Date / Month /Year)

Caste Category

:_________________________________

(Example : SC/ ST/ BC-A/ BC-B/ BC-C/BC-D/OC/ OBC/BC-E)

Special Category

:_________________________________

(Example : Physical Handy caped / Blind / Def & Dum / NCC)

Identification Marks

( Example : A+, A- , B+, B- , AB+, AB- , O + , O- etc.)

(1) __________________________________:
(2) __________________________________

Student e-mail

:_________________________________

Father e-mail : _____________________________________

Name of the Proctor

:__________________________________ Proctor Phone Number _______________________________

PARENT CORRESPONDENCE ADDRESS :

H.No.

:_______________________________________

Street

:_______________________________________

Village /Area
(Post) (Town)

:_______________________________________

City /Mandal

: _______________________________________

District

:________________________________________ Pin code

State

:________________________________________

:_____________________________________

Parent Mobile No: ________________________________________

Student Mobile No:________________________________________

Previous Exam Details:
Qualifying Exam

Hall Ticket No.

Group

Passed Month & Year

Max.Marks

Secured Marks

Div/Grade

B IE

Signature of the Student