Registration Form
ACADEMIC COURSE
DISTANCE EDUCATION
SECONDARY COURSE
SENIOR SECONDARY COURSE
NIOS
NWAC
APRIL-MAY EXAM
OCTOBER-NOVEMBER EXAM
ON-DEMAND EXAM
Year
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Name of Candidate(Capital Letters)
:
Fathers Name(Capital Letters)
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Mothers name(Capital Letters)
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Name of Guardian(Capital Letters)for Orphans
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Postal Address
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Contact Number
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Email Id
Phone No
Mobile No
Date of Birth
:
Age
:
Gender
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Course Applied For
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Medium of Study
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Mother Tongue
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Nationality
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Religion
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Your Previous Qualification
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Father's Education Qualification
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Mother's Education Qualification
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Place of Residence
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Employment
:
Annual Family Income
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Examination Center Selected District
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Choose Subject
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Subject I
Subject II
Subject III
Subject IV
Subject V
X Board Exam Details
:
Year of Passing
Roll No
Board
Registration Fees Details
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Reg.Fees Rs.
DD No.
Date of Bank Draft
Bank Name
Permanent Address
:

DECLARATION OF STUDENT / PARENT

I hereby declare that, I am enrolling myself for the correspondence course of distance education. I have gone through the brochure and website of this course and I have fully understood it. I agree and accept the terms and conditions said in the brochure and website. I also agree that it is my personal responsibility to study the course and to pass the examination.

All disputes and claims will be resolved by way of Arbitration according to the Arbitration and Conciliation Act, 1996 and the Jurisdiction will be in Ernakulam district. If the applicant violates any of the terms of the rules and regulations of the course he / she is likely to be terminated and no part of the fee collected would be refunded. The institution will not be liable for any failure due to act of God, act of Government or Statutory undertaking oranything beyond the institution's control, nor we would be liable for any incidental or consequential loss or damage arising out of this.

I accept the declaration
Date
:
Place
:
List Of Documents with Application(Specify No)
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