One Year Repeaters Batch Form

Exclusive Coaching for XIIth Pass Students

Student Information

Registration only for girls

Please enter your name as it appears on any government approved photo ID such as aadhar card, PAN, school admit card, DOB certificate, etc

Mode of Exam*

Offline (Students from Jamshedpur only)

Online (Students outside Jamshedpur only)

First Name*

Middle Name

Last Name*

Gender*

Date of Birth*

Upload Passport Size Photo*

File size limit: 5 MB | File Format: JPEG or PNG

Student Identification*

Enter the ID Number*

Contact Information

Address that we can use to send mail to. Usually, this is the address where you currently live.
Please locate Postal Code or Post Office using this indiapost.gov.in

Primary Number*

Alternate Number

Email*

Address Line 1*

Address Line 2*

City*

District*

State*

Country*

Pin Code*

Academic Information

Board of Exam*

Others

Medium of Instruction*

Mother Tongue*

School Name*

School City*

School State*

Class XII certificate if received

Class XII percentage

Class X marksheet

The file should be in jpeg, png or pdf format

Class X marks

No of NEET attempts

Last NEET score

Family Information

Father’s Title*

Father’s First Name*

Father’s Last Name*

Father’s Phone Number*

Father’s Profession*

Father’s yearly income

Mother’s Title*

Mother’s First Name*

Mother’s Last Name*

Number of Brothers*

Number of Sisters*