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ONLINE  APPLICATION  FORM

Important Instructions

Before you start applying online read the following:

  • Application Form Fee is different for different Course (inclusive of Service Tax).
  • Payment of Application Form Fee can be made either by sending the DD in favour of "BANSAL CLASSES PVT LTD" payable at "KOTA (Rajasthan)" or
  • Application Form Fee can be paid Online using Credit Card, Debit Card or Net Banking facility once you are done with filling the Online Application Form.
  • Application Form Fee (inclusive of Service Tax) is not refundable under any circumstances whether you pay by Demand Draft or Online.

Instruction Related to Fill Personal Details
  • Fields mark with * are mandatory.
  • Read / Review all information entered by you before submitting for Payment.
  • You can see the error message by pointing cursor on error image.
Engineering Class Room Courses
Courses (Eligibility)
Early Nucleus Phase II (Class XI to XII Moving Students)
Azusa (Class XII Pass Students)
Sterling (Class XII Pass Students)

Basic Details
       
  Select Stream * :    
  Current Class * :    
Course Name * :  
Preferred Study Medium * :
 
Study Centre Name * :  
Entrance Test Centre (1st Choice) * :  
Entrance Test Centre (2nd Choice) * :    
Ex Bansal Roll No :   (Leave blank if you are not a Bansalite)
App Form Send Through * :  
How do you come to know about BANSAL * :  

Personal Details
Candidate's Name * :  
Gender * :
 
Date of Birth as per High School (10th) Certificate * :      
Nationality * :
 
Category * :  
Blood Group :
Father's Name * :  
Father's Occupation :
Father's Designation :
Mother's Name * :  
Mother's Occupation :
Mother's Designation :
Total Annual Income (from all sources) :

Address and Contact Details
Address Line No. 1 * :  
Address Line No. 2 :
City / Town / Post / Tehsil / District * :  
Pin Code * :  
State Name * :  
Mobile No. * :    
STD Code :  
Phone No. :  
Alternate Phone No. :  
E-Mail Address :  
(Do not leave any column blank between E-Mail ID.)
Alternate E-Mail Address :  
(Do not leave any column blank between E-Mail ID.)

Academic (Qualification) Details
Name of School you have studied in Class 10th * :  
Name of City you have studied in Class 10th * :  
Education Board  * :  
Academic Record * :
Aggregate % Passing Year  
Class IX    
Class X    
Class XI    
Class XII    
Marks/Per Range Grade Grade Point
91-100 A1 10
81-90 A2 9
71-80 B1 8
61-70 B2 7
51-60 C1 6
41-50 C2 5
33-40 D 4
21-32 E1
00-20 E2
No. of Attempts
(Only for Class XII Pass Students)
:
JEE Advanced :
JEE Main :
AIPMT :
JEE Main Rank :   (Only for Class XII Pass Students)
JEE Advanced Rank :   (Only for Class XII Pass Students)
Mark, if participate in any of the following
Competitive Exam Attempted
:
Remark :

Final Submission and Verification