Student Request Form

Specify Semester *
- Select -123456

Specify Last Date of Payment of Fees *

Name of the Bank *

Branch Name & Branch code *

Place *

State *

To be applied for in April and/or November

Personal Details

Enrollment No *

Batch
- None -B.Sc. BiotechnologyB.Sc. MicrobiologyM.Sc. BiotechnologyM.Sc. MicrobiologyM.Sc. Bioinformatics

First Name (as per Class X certificate) *

Surname (as per Class X certificate) *

Father’s Name (as per Class X certificate) *

Mother’s Name (as per Class X certificate) *

Email id *

Telephone/ Mobile No. *

Hosteler/Day-Scholar *
- Select -HostelerDay-Scholar

Address *

Other Relevant Details

Declaration *
I, hereby declare that the information given above is complete and true to the best of my knowledge and based on records.