Registration | NIILM University

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Basic Info

First Name *

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Last Name

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Father Name

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Father Occupation

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Mother Name

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Mother Occupation

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Phone *

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Email *

Gender *

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Admission Type *

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Date Of Birth *

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Place of Birth

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Aadhaar No *

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PPP No

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Category *

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Category-2

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Domicile of Haryana

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Family Income (Monthly)

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Emergency Phone

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Religion

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Nationality

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Marital Status

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Blood Group

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National ID

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Passport No

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Admission Date *

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Subject/Specialization 1 *

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Subject/Specialization 2 *

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Subject/Specialization 3 *

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Present Address

State

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District/City

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Address

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Pin Code

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Permanent Address

State*

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District/City

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Address

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Pin Code

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Educational Info

Student type

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Application source

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Facility heading

Hostel *

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Transportation *

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Masters

Name of the Institution

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Stream/Degree

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Year of Passing

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Percentage

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Board/University

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Subject/Specialization

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Graduation

Name of the Institution

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Stream/Degree

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Year of Passing

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Percentage

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Board/University

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Subject/Specialization

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Intermediate (12th)

Name of the Institution

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Stream/Degree

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Year of Passing

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Percentage

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Board/University

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Subject/Specialization

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Maticulatino (10th)

Name of the Institution

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Stream/Degree

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Year of Passing

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Percentage

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Board/University

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Subject/Specialization

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Academic Information

Entry Type *

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school in application enroll *

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Program *

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Session *

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Semester *

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Section *

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Remarks

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Reference

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Counsellor Name

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Total Work Experience (Year & Month)

Name of Organization

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Designation Held

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Name of Responsibility

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Duration

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No of Years

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Guardians information

Relation

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Name

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Occupation

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Phone

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Address

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Documents

Photo: Best Resolution Height- 300 PX, Width- 300 PX

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Signature: Best Resolution Height- 100 PX, Width- 300 PX

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Upload Document

Please Enter Program