Edutantra | Registration

University *

Category *

Programme *

Upload Photo

Upload Signature

Pattern *

Year *

Month *

(As entered in Secondary/ Senior Secondary Certificate) *

Student Name *

Fathers Name *

Mothers Name *

Student Gender *

Date Of Birth *

( Any change in address should be immediately communicated to the institute) *

Permanent Address	Mailing Address Same as Permanent Address

City *

State *

City *

State *

Pin Code *

MOB No *

Pin Code *

MOB No *

Alternate No *

E-Mail (UserId)*

Alternate No *

E-Mail *

Nationality *

Category *

Employment Category *

Have you ever been debarred by any University/ Board? (if yes give details) *

DETAILS OF PREVIOUS EXAMINATIONS PASSED FROM OTHER UNIVERSITY

enclose duly attested/ Notarized, self-attested photocopies of the previous Mark card/ documents/ certificates)

SR NO	NAME OF EXAM	ROLL No.	YEAR OF PASSING	PERCENT/ GRADE	NAME OF UNIVERSITY/ BOARD
1	10TH
2	12TH
3	Graduation
4	Post Graduation
5	Others

EMPLOYMENT DETAILS

SR NO	EMPLOYER NAME	DESIGNATION	TENURE
1
2
3
4
5

Mode Of Payment *

DD/Cheque No./ Online Transaction ID: *

Date *

Bank Name *

Amount *

Check List of Attested Certificates to be uploaded on the website:

1. Degree Certificate

2. Diploma Certificate

3. Provisional Certificate

4. Degree All Year Marksheet

5. Marriage Certificate

6. Photos 3 Nos.

7. Service Certificate

8. Copy of Passport

9. Photo Identity

10. High School Mark sheet and Certificate

11. Intermediate Mark sheet and Certificate

CERTIFICATE OF UNDERTAKING

I hereby declare that the information furnished herein above is true and correct to the best of my knowledge and belief. I further declare that the attested copies of the certificates submitted by me at the time of admission are the true copies of the originals. I am aware about the rules and regulations of the University. I have understood the payment terms and guidelines. I agree not to countermand and to honour all the postdated cheques enclosed by me/ submitted by me towards the Installment Facility. In case any information is found incorrect, at any stage, I agree to forego the fee deposited and also the claim for admission. I understand that in case I withdraw from the program I will not be entitled to claim any refund of amount paid. I am aware that I have applied for the distance programs offered by the university and my course delivery would happen through the study material and video lectures uploaded on the website. My signature below certifies that I have read understood and agree to the rules and regulations, including “Legal Aspects” and my financial responsibilities. I authorize Edutantra for making communication with the university on my behalf.

EduTantra Form