*Student Name  
*Father/Mother Name  
*Institution Name  
*ADHAR No./PAN no./Passport No.  
*Student Registration Number  
*Class ( I/II/III/IV)  
*Address  
*Mobile No.  
*Pin/Zip Code  
*E-Mail Id  
*Type of Service  
*Nationality/Origin  
*Faculty  
*Course  
*Fees  
 
  * fields are mandatory