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International Educational Council

Application for Student Registration

Choose Course: *

1.Applicant's Name *

(in capital and as in the SSLC or equivalent certificate)

2.Date of Birth *

Day Month Year

3.Gender *

female male

4.a.Father's Name *

b.Mother's Name *

5.Relegion

Caste
OBC SC/ST

6.Qualification

Course	University/ Board	Register Number	Year of Passing	% of passing

7.Address 1:HouseName/HouseNo: *

2.Place/Road *

3.Post office

4.District *

Pincode :

5.Phone No(with STD code) *

Mobile no:

6.Email

8.Security Code *

*DECLARATION

I have carefully read the rules and regulations mentioned on reverse of this
application and agree to abide by them. I also hereby declare that the
information furnished by me is true and correct to the best of my knowledge.

I Agree

IN ASSOCIATION WITH

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