*Student Name:

*Father's Name:

*Student Code(As per Banglar Shiksha Portal):

*Registration No:

*Aadhar No:

*Mobile No:

*Email Id:

Optional Elective Subject(If you want to change from 3 Elective Subject):

*Signature of Applicant should be in black ink only, Photo size should be between 10KB and 50KB with minimum resolution 120 X 150 pix approx. Allowed file type - jpg/jpeg/png :