Registration Form – XXX Form

Step 1

Registration Form For PGDPC

Payment Information

Mode of Payment*

Pay OnlineDeposit NumberDemand Draft Number

Step 2

Registration Form For PGDPC

First Name*

Last Name*

Upload your Photo

Nationality*

Enter Email*

Confirm Email*

Gender

MaleFemale

Date of Birth*

Marital Status

Marital StatusSingleMarried

Permanent Address

Location (City)*

State

Country

Pin Code

Postal Address

Postal Location (City)*

Postal State

Postal Country

Postal Pin Code

Contact Number (Mobile) :*

Contact Number (Residence) :*

Parent/Guardian

ParentGuardian

Father’s Name*

Contact Number* :

Mother's Name*

Contact Number* :

Occupation of Parents

BusinessGovt. ServiceProfessionalsPvt. ServiceOthers

Step 3

Registration Form For PGDPC

Academic details of the Student.

Exam Year

Title of course (Please specify degree & full course name)

Main Subjects

Marks%

English%

School Name/College Name with city

Post Graduation (if proceeding)

Graduation*

12th Standard*

Other Qualification

Scholarships/ Extra-Curricular interests/ achievements/ position of responsibility held

No. 1

No. 2

No. 3

Ref No. 1

Ref No. 2

Ref No. 3

Do you suffer from any health disorder?*

YesNo

If yes, state