SMR Coaching Centre

New Student Registration

Course Name*

Candidate Name*

Gender*

Father's/Husband's/Guardian's Name*

Mother's Name*

Nationality*

Religion*

Caste*

Date of birth*

Adhar No

Physically Challenged*

Mobile No*

Alternative Phone No :

E-mail*

Address, Height(CM), Weight(CM), Chest Size(CM)*

State Name*

District Name*

Block/Municipality Name*

Panchayat Name/Ward No*

Pin Code* :

Higher Qualification*

Recent photo (300 Kb)* : Upload Later

Qualifying Certificate (300 Kb)* Upload Later

Ration Card/ Aadhaar Card/ Voter Id (300 Kb)* Upload Later

Declaration

I hereby declare that all the information stated in this application form are true to the best of my knowledge. I have followed the prospectus carefully and understood all the rules and regulation agree to abide by them. In case of any dispute likely educational qualification, period of study etc made in my application form, I understand that my admission is liable to cancellation. I am taking admission in SMR Coaching online today.

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