BSMS Enquiry Form : (2022-2023)

"*" indicates required fields

Date*

Student Name*

First Last

Email*

Gender*

Age*

DOB*

Religion*

Caste / Community*

Nationality*

Name of Father/ Mother / Guardian*

First Last

Occupation & Annual Income of Father /Mother*

Address for Correspondence*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Mobile No.*

Land Line

Address of Local Guardian

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Mobile No.

Land Line

Permanent Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Mobile No.

Land Line

NEET Roll No.*

Score*

Rank No.*

KEAM Roll No.

Score

Rank No.

Qualification*

Name of Exam*

Year of Passing*

Name of the Institution*

Name of the University / Board*

Percentage of Marks obtained*

Reference Name

First Last

Mobile Phone

Reference Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Declaration*

I do hereby declare that all statements made in this application are correct. I do hereby promise, if admitted to abide by the rules and regulations of this institution, I will not take part in any activities, which hamper the interest of the Institution, and the decision of the authorities will be final and binding on me.

Name

This field is for validation purposes and should be left unchanged.