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ONLINE  APPLICATION  FORM - PRE - MEDICAL

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.
Pre - Medical Class Room Courses
Courses (Eligibility)
Bull's Eye (Class X to XI Moving Students)
Nucleus (Class XI to XII Moving 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)
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 :
NEET/AIIMS :
Mark, if participate in any of the following
Competitive Exam Attempted
:
Remark :

Final Submission and Verification