Examination *
SSLCAICLCBSEAICTTHSLCICSCSSC

a) Name of School *

b) Reg. Number *

Month *
JANUARYFEBRUARYMARCHAPRILMAYJUNEJULYAUGUSTSEPTEMBEROCTOBERNOVEMBERDECEMBER

Year *
Select 197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016201720182019202020212022

a) Name of the examination *
Select SSLCHSEPDCAISSCEICSETHSLCVHSE

b) Board/university *
Select Anna UniversityAssam Agricultural UniversityAssam Agricultural UniversityAnnamalai Assam UniversityAvinashilingam University for WomenAwadhesh Pratap Singh UniversityBanaras Hindu UniversityBanasthali VidyapithBangalore UniversityBarkatullah UniversityBerhampur UniversityBharat UniversityBharathiar UniversityBharathidasan UniversityBharati Vidyapeeth UniversityBhavnagar UniversityBirla Institute of Technology MesraBirsa Agricultural UniversityBundelkhand UniversityCentral Agricultural UniversityChaudhary Charan Singh UniversityChaudhary Devi Lal UniversityChhatrapati Shahu Ji Maharaj UniversityChrist UniversityCochin University of Science and TechnologyCSK Himachal Pradesh Agricultural UniversityDakshina Bharat Hindi Prachar SabhaDeen Dayal Upadhyay Gorakhpur UniversityDev Sanskriti VishwavidyalayaDevi Ahilya VishwavidyalayaDharmsinh Desai UniversityDibrugarh UniversityDravidian UniversityEnglish and Foreign Languages UniversityFakir Mohan UniversityForest Research InstituteGandhigram Rural UniversityGauhati UniversityGoa UniversityGujarat Ayurved UniversityGujarat UniversityGujarat VidyapithGulbarga UniversityGuru Ghasidas UniversityGuru Gobind Singh Indraprastha UniversityGuru Jambeshwar UniversityGuru Nanak Dev UniversityGurukula Kangri VishwavidyalayaHemchandracharya North Gujarat UniversityHidayatullah National Law UniversityIASE UniversityICFAI University DehradunICFAI University TripuraIndian Agricultural Research InstituteIndian Institute of Foreign TradeIndian Institute of ScienceIndian Institute of Technology BombayIndian Institute of Technology DelhiIndian Institute of Technology GuwahatiIndian Institute of Technology KanpurIndian Institute of Technology KharagpurIndian Institute of Technology MadrasIndian Institute of Technology RoorkeeIndian School of MinesIndian Statistical InstituteIndian Veterinary Research Instituteindira Gandhi Krishi VishwavidyalayaIndira Kala Sangeet VishwavidyalayaInstitute of Technology and ManagementIntegral UniversityJadavpur UniversityJai Narain Vyas UniversityJai Prakash VishwavidyalayaJain Vishva Bharati UniversityJamia HamdardJamia Millia IslamiaJawaharlal Nehru Krishi VishwavidyalayaJawaharlal Nehru Technological UniversityJawaharlal Nehru UniversityJaypee Institute of Information TechnologyJaypee University of Information TechnologyJiwaji UniversityJunagadh Agricultural UniversityKakatiya UniversityKannada UniversityKannur UniversityKarnatak UniversityKarunya UniversityKavikulguru Kalidas Sanskrit VishwavidyalayaKerala Agricultural UniversityKIIT UniversityKumaun UniversityKurukshetra UniversityKuvempu UniversityLalit Narayan Mithila UniversityMadurai Kamaraj UniversityMagadh UniversityMaharashtra University of Health SciencesMaharshi Dayanand Saraswati UniversityMahatma Gandhi Kashi VidyapeethMahatma Gandhi UniversityMahatma Jyotiba Phule Rohilkhand UniversityMahatma Phule Krishi VidyapeethMalaviya National Institue of Technology JaipurMangalore UniversityManipal UniversityManipur UniversityManonmaniam Sundaranar UniversityMarathwada Agricultural UniversityMaulana Azad National Institute of TechnologyMaulana Azad National Urdu UniversityMizoram UniversityMody Institute of Technology & ScienceMohan Lal Sukhadia UniversityMother Teresa Womens UniversityMotilal Nehru National Institute of TechnologyNagaland UniversityNALSAR University of LawNational Dairy Research InstituteNational Institute of Technology CalicutNational Institute of Technology KarnatakaNational Institute of Technology HamirpurNational Institute of Technology JamshedpurNational Institute of Technology KurukshetraNational Institute of Technology SilcharNational Institute of Technology WarangalNational Law Institute UniversityNational Law School of India UniversityNational Law UniversityNavsari Agricultural UniversityNetaji Subhas Institute of TechnologyNirma University of Science and TechnologyNizams Institute of Medical SciencesNorth Eastern Hill UniversityNorth Maharashtra UniversityNorth Orissa UniversityNTR University of Health SciencesOrissa University of Agriculture and TechnologyOsmania UniversityPadmashree Dr. D.Y. Patil VidyapithPandit Ravishankar Shukla UniversityPanjab UniversityPatna UniversityPEC University of TechnologyPeriyar UniversityPondicherry UniversityPotti Sreeramulu Telugu UniversityPravara Rural UniversityPrist UniversityPunjab Agricultural UniversityPunjab Technical UniversityPunjabi UniversityRabindra Bharati UniversityRajasthan Agricultural UniversityRajasthan Ayurved UniversityRajasthan Sanskrit UniversityRajasthan University of Health SciencesRajendra Agricultural UniversityRajiv Gandhi Proudyogiki VishwavidyalayaRajiv Gandhi UniversityRajiv Gandhi University of Health SciencesRanchi UniversityRani Durgavati VishwavidyalayaRashtriya Sanskrit SansthanRashtriya Sanskrit VidyapeethaSambalpur UniversitySampurnanand Sanskrit UniversitySant Gadge Baba Amravati UniversitySardar Patel UniversitySASTRA UniversitySathyabama UniversitySaurashtra UniversitySaveetha UniversitySchool of Planning and ArchitectureShivaji UniversityShree Somnath Sanskrit UniversityShri Guru Ram Rai Education MissionShri Jagannath Sanskrit VishvavidyalayaShri Mata Vaishno Devi UniversitySido Kanhu Murmu UniversitySikkim Manipal UniversitySree Sankaracharya University of SanskritSri Krishnadevaya UniversitySri Padmavati Mahila VisvavidyalayamSri Ramachandra UniversitySri Venkateswara UniversitySRM UniversitySumandeep Vidyapeeth UniversitySymbiosis International UniversityTamil Nadu Agricultural UniversityTamil Nadu Dr Ambedkar Law UniversityTamil Nadu Dr.M.G.R.Medical UniversityTamil UniversityTata Institute of Social SciencesTERI UniversityTezpur UniversityThapar UniversityThe Indian Law InstituteThe LNM Institute of Information TechnologyThe Maharaja Sayajirao University of BarodaThe University of BurdwanThiruvallauvar UniversityTilak Maharashtra UniversityTilka Manjhi Bhagalpur UniversityTripura UniversityTumkur UniversityUniversity of Agricultural Sciences BangaloreUniversity of Agricultural Sciences DharwadUniversity of BikanerUniversity of CalcuttaUniversity of CalicutUniversity of DelhiUniversity of HyderabadUniversity of JammuUniversity of KalyaniUniversity of KashmirUniversity of KeralaUniversity of KotaUniversity of LucknowUniversity of MadrasUniversity of MumbaiUniversity of MysoreUniversity of North BengalUniversity of Petroleum and Energy StudiesUniversity of PuneUniversity of RajasthanUniversity of SolapurUtkal UniversityUtkal University of CultureUttar Banga Krishi ViswavidyalayaUttar Pradesh Technical UniversityVeer Bahadur Singh Purvanchal UniversityVeer Kunwar Singh UniversityVeer Narmad South Gujarat UniversityVidyasagar UniversityVikram UniversityVinayaka Missions UniversityVinoba Bhave UniversityVisva-Bharati UniversityVisveswaraiah Technological UniversityKERALA BOARD OF PUBLIC EXAMINATIONCBSEBHSEBVHSEISCEMGR Medical UniversityHEMWATI NANDAN BAHUGUNA GARHWAL UNIVERSITYSree Chandrasekharendra saraswathi viswamaha vidyalayamThe West Bengal University of HSOtherR.G.U.H.S BanglorePanchakarma R.G.U.H.S BangloreNational University of Advanced Legal Studies (NUALS)AISSEAICEState Board of School Examinations TamilnaduKerala University of Health Sciences (KUHS)CBSCAcharya Nagarjuna University Acharya Nagarjuna University Alagappa UniversityAligarh Muslim UniversityAll India Institute of Medical SciencesAllahabad Agricultural InstituteAllahabad Agricultural InstituteAllahabad UniversityAmrita Vishwa VidyapeethamAnand Agricultural UniversityAndhra University

c) Number of chance availed *
1 2

d) Month /Year *
JANUARYFEBRUARYMARCHAPRILMAYJUNEJULYAUGUSTSEPTEMBEROCTOBERNOVEMBERDECEMBER

Select * 197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016201720182019202020212022

Register No *

e) Total (%) *

Grade *

f) Percentage of marks secured: Physics (%) *

Chemistry (%) *

Biology (%) *

g) Name of the institution last attended *

h) TC No & Date *

Date *

a) Name of Parent or Guardian *

b) Relationship *

c) Occupation *

Annual income *

d) House Name *

e) Post *

f) Street / District *

eg : Ollur / Thrissur

g) Pin *

a) House Name

b) Post

c) Street / District

d) Pin

Phone No: [Parent]

Mobile No: Mother

Father

Mobile No[Student] *

Email ID Parent

Email ID: [Student] *

Blood Group
O+A+B+AB+O-A-B-AB-

Aadhaar No

• SSLC Certificate
• Plus Two Certificate & Mark List
• NEET 2021 Admit Card
• NEET 2021 Score Card
• KEAM 2021 Data Sheet
• Certificated issued by the President Vaidyaratnam Ayurvedic Educational Society (for special criteria management seats notified in the prospectus)
• Proof on remittance on application for Rs.1000/-
• Photo (jpg / jpeg format)
• Signature (jpg / jpeg format)

I hereby declare that the details stated above are true and correct to the best of my knowledge and belief, and I will be responsible for any false information.

Date

Signature of Student

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