STEP : 01 || REGISTRATION FORM
Applicant Name:*
[ Please do not use any prefix such as Mr. or Ms. etc ] [ Must be Strictly matched as per 10th Marksheet ]
Father's Name:*
[Do not use any prefix such as Shri or Dr. Etc.]
Mother Name:*
[Do not use any prefix such as Smt Etc.]
Date of Birth:*
[ Date of Birth as recorded in the Matriculation Examination Certificate/Any Valid Proof ]
Gender:*
Income Group:*
Religion:*
Marital Status:*
Nationality :*
Aadhar:*
OR
Domicile State:*
Domicile Certificate No:*
[ Enter "NONE" if Not Eligible. ]
Caste/Category:*
Caste/Category Certificate No:*
[ Enter "NONE" if Not Eligible. ]
Minority:*
CORRESPONDENCE ADDRESS [ पत्राचार का पता ]
Address :*
[ Don't Enter Your Name In The Address Field's ]
State:*
District :*
Pin Code:*
PERMANENT ADDRESS [ स्थाई पता ]
Address :*
[ Don't Enter Your Name In The Address Field's ]
State:*
District :*
Pin Code:*

Mobile Number :*
[ 10 Digit Mobile Number ]
E-Mail Address:* / Confirm E-Mail Address:*
Password:* / Confirm Password:*(8 to 12 character)
[ This Password will be use to complete Pending Registration Form/Print Filled up Form ]
Not Allowed ➤ Space,",',~,`,Comma,=

I hereby declare that the particulars filled are true, correct and complete to the best of my knowledge and belief and nothing has been concealed, In case any of the information is found to be false, incorrect or misleading at any stage I shall have no claim against cancellation of my candidature and/or taking other legal action as deemed fit by Maa Shakumbhari University.

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