IAPT PRMO-2017

Student Registration Form

Students (Born on or after 01/08/1998 and studying in classes 8th, 9th, 10th and 11th) who wish to appear for the IAPT PRMO 2017
Examinations are to fill the below given details in BLOCK LETTERS only and Hand over the Registration Form to their School/
Institution.

Name of the Student: .....

Gender : (Male / Female)

Class / Standard : .......

School Name : .......

Town /City & Pin Code: .. .....

Date of Birth : DD MM YYYY

Residential Address : .....

: ....

: .......

City : .......

District : .......

State : .......

Pin Code : .......

Mobile No : .......

E-Mail ID : .......

Declaration: I hereby declare that the details furnished herein are true to the best of my knowledge.

Date:

Place: (Signature of the Student)