Devote Academy Naini Allahabad

Registration Form

Registration No:

Course Medium:

Name :(in block letter)

Father/Husband Name:

Mother Name:

Date of birth:

Nationality:

Marital Status:

Married Unmarried

Gender:

Male Female

Category:

Mailing Address:

Address:

City:

District

State:

Pincode:

Contact No.:

Permanent Address:

Same as Mailing Address:

Address :

City:

District

State:

Pincode:

Contact No.:

Email :

Select list:

Aadhar/Other No:

Photo:

Thumb Impression:

Signature: Your Signature

Examination Passed	Name of stream	Board/University	Year of passing	Marks obtained	Max. Marks	% of Marks
Class 5th / above
INTERMEDIATE
GRADUATION
POST GRADUATION
ANY OTHER

Date :

Desclaimer

I affirm that all the information provided in the application form is true to my knowledge and belief. I also agree to abide by the rules and regulations of the institute and conditions printed overleaf. On being granted admission, i also agree to pay all the fees and other charges as per the schedule framed by the institute. fees once paid will not be return or adjusted in any case.