AIIMS Patna | Examination

Student Registration Form

Student Information

Course Name*

SESSION*

Admission Date(As per joining report)

Rank*

First Name*

Middle Name

Last Name

Date of Birth*

Original Category*

Category Selected*

Gender*

Nationality*

Religion*

Email Address*

Identification Mark*

Blood Group*

Father Name*

Mother Name*

Parent Email Address

Contact Details

Correspondance Address

State*

District*

Town/Village*

Police Station*

Pin*

Land Line

Mobile*

Street Adress*

Permanent Address

State*

District*

Town/Village*

Police Station*

Pin*

Land Line

Mobile*

Street Adress*

Emergency/Local Guardian Contact

Guardian First Name*

Guardian Last Name

Guardian Mobile No*

Guardian Email Address

Relationship Type*

Guardian Address*

Educational Qualification

Matriculation

School Name*

State*

City*

Board*

Passing Year*

% of Marks*

Division*

10+2

College/School Name*

State*

City*

Board*

Passing Year*

% of Marks*

Division*

Upload Image*maximum file size allowed 50kb and image only

Upload Signature*maximum file size allowed 20kb and image only

AIIMS Patna Student Management System

Student Registration Form

Student Information

Contact Details

Educational Qualification

Matriculation

10+2