Personal Information : (Registration Fees Rs.500/-)

Surname
Student Name
Father Name
Name of the school studied in Std -12:
Village / City :
District :
Medium
12th Result in Percentage :
Expected Marks in Neet Exam _____ (Out of 720) :
Parent's Contact No. (Use WhatsApp No. If Available)
Student's Contact No. (Use WhatsApp No. If Available)