ONLINE ADMISSION FORM

Name in Full

Surname

First Name

Father’s/Husband’s Name

Mother’s Name

Address

A. Correspondence

B. Permanent

Date Of The Birth

Place of Birth

Contact Number

Emergency Cont. Number

Email ID

Alternate E-mail id

Gender

Marital Status

Social Category

Caste Certificate

Caste Validity

Non Creamy Layer

Physically Handicapped

UNDERTAKING

I understand and agree that the registration fee is neither transferable nor refundable.

We do hereby confirm that above mentioned information is true to the best of my knowledge.

Person Name

Date

Student Name

PAYMENT DETAILS:

For confirmation of admission kindly pay the registration amount. Online Payment Details are mentioned below.

Account Name: Dnyan Ganga Education Trust
Bank Name: NKGSB Bank Ltd
Account Number: 107110600000001
Branch: KAVESAR, GHODBUNDER ROAD, THANE
IFSC Code: NKGS0000107

CONFIRMATION OF SUCCESSFULLY RECEIVED PAYMENT

Online Transaction Details:

Name of the Bank

Transaction Id

Date Of Transaction

Amount Paid

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