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ONLINE  APPLICATION  FORM


Basic Details
       
  Select Stream * :    
  Current Class * :    
Course Name * :  
Preferred Study Medium * :
 
Study Centre Choice * :  
Test Centre Choice * :  
  Are you Bansalite?    
  BC Roll No        
Registration Type * :
Previous Registration / Control No :     (Leave it, if you are first time appear in 2017)

Personal Details
Candidate's Name * :  
Gender * :
 
Date of Birth as per School * :      
Nationality * :
   
Category * :  
Father's Name * :  
Mother's Name * :  

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

Academic (Qualification) Details
Current School Name * :  
Current School City Name * :  
Education Board  * :  
Remark :

Final Submission and Verification