etlab | BTECH Student Registration for Academic Year 2023

Personal Details

First Name *

Middle Name

Last Name

Gender *

Blood Group

Date of Birth *

Mother Tongue

Place of Birth

Nationality

Religion *

Caste *

Eligible Reservation Category

Economicaly Backward

Aadhar No *

Differently Abled

Admission Details

Admission for *

Academic Year *

Course Opted *

Quota *

Type

Admitted Reservation Category

Fee Concession Eligibility *

Income Category *

Entrance Type

Entrance Roll No

Entrance Rank

Community *

Nativity

Qualification

Higher Secondary School Details

Board *

Year *

Reg No *

Higher Secondary Percentage Obtained ( HSE / VHSE kerala students should enter combined XI & XII marks and others need to enter XII marks only.)

Physics Mark *

Physics (%) *

Chemistry Mark *

Chemistry (%) *

Maths Mark *

Maths (%) *

Maths & Physics & Chemistry(%) *

Total Mark *

Overall (%) *

Secondary School Details

Board *

Year *

Reg No *

TC Details

Last Institute (As per TC) *

TC No *

TC Date *

Contact Details

Present Address

House Name *

Street *

Post / Street 2 *

District *

Pin *

State *

Permanent Address [ same as present address ]

House Name *

Street *

Post / Street 2 *

District *

Pin *

State *

Student Phone No *

Email *

Land Phone

Personal Marks for identification

Personal Marks 1

Personal Marks 2

Bank Details

Name of Bank

Account No

Name of Branch

IFSC Code

Hostel Facilities

Do you need Hostel Facilities

NoYes

Parent Details

Father's Name *

Mother's Name *

Father's Occupation

Mother's Occupation

Father's \ Guardian's Mobile No *

Mother's Mobile No

Parent Email

Phone Office

Select Guardian

Annual Income

Name of Guardian

Relationship with the student

Address of Guardian

Guardian's No

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BTECH Student Registration 2023