Registration Form

Medicaps Institute Of
Technology & Management
A.B. Road,Pigdambar,Indore-453331 Phone:(0731)4020492,2856294,4020492 Fax:2856263

Student Name:

Father's Name:

Mother's Name:

Local Address:

Contact No. :

Permanent Address :

Contact No. :

Guardian Name:

Guardian Adress:

Contact No. :

Category: UR/X Documents Submitted: 10th Class Marksheet (Photocopy)

ST 12th Class Marksheet (Photocopy)

SC Transfer Certificate (Original)

OBC Migration Certificate (Original)

Caste Certificate (Original)

Graduation Certificate (Photocopy)

Gap Certificate (Original)

Course:

Branch:

Academic Details :

School / College Year Of Passing Percentage Board / University

High School

Higher Secondary

Graduation

Post Graduation