Indian Institute of Technology Indore

AY 2019-20 - Spring Semester

Student Biodata form

Name of the Student :

Roll No. :

Name of Program :

Discipline :

Date of Birth (DOB) :

Country of Birth :

Mobile No. / Contact No. :

Blood Group :

Birth Category

Aadhaar No. (Optional) :

Personal email ID :

Father’s Name :

Father’s Contact No. and email ID :

Mother’s Name :

Any Medical problem AS ON DATE :

Mother’s Contact No. and email ID :

:
Correspondence address

:
Permanent Address

Local Guardian Name, Contact No., :

Address and email ID
(if any)