Registration Form-SSSA

NAME*

First

Last
STUDY*
ENTER THE COURSE/DEGREE NAME YOU R STUDYING
eg.F.Y.B.A.
COLLEGE NAME*
BIRTH DATE*

MM
/
DD
/
YYYY
BLOOD GROUP
NATIVE PLACE*
PRESENT ADDRESS*

Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
PERMANENT ADDRESS*

Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
MOBILE NO.*
YOUR OWN MOBILE NO.
MOBILE NO.(R)*
HOME NO.
EMAIL ID
FATHER'S FULL NAME*
MOTHER'S NAME*
BROTHER/SISTER'S INFORMATION*
ENTER YOUR BROTHER/SISTER'S NAME,AGE & STUDY
YOUR PHOTOGRAPH
UPLOAD YOUR PASSPORT SIZE(SMALL IN SIZE)
PHOTOGRAPH ONLY
Image Verification
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