Last Date for Online Application is 16.06.2017 & Hard copy submission is 23.06.2017 at 5.00 p.m. Read all instructions carefully before filling the application.


Enter the Payment Details here. (Online Payment Click Here)

Choose Category Transaction ID Transaction Date (dd/mm/yyyy) Amount

01. Name of Candidate *
02. Date of Birth * (dd/mm/yyyy)
03. Gender * Male      Female
04. Father's/Guardian name *
05. Mother's name *
06. Mailing address *
Upload Photo
Image Size must be 150x180px
     City *
     State *
     Country *
     Pin Code *
Fax    
     Telephone number
Mobile *
     Alternate Mobile
07. Permanent address *
If same as Mailing Address,Tick here     & If not fill below,
     City *
     State *
     Country *
     Pin Code *
         
08. Email Id *
09. Nationality *
Indian                              Others          
10. Name & Place of school
      last studied
11. Subjects studied in XII *

12.Academic Details*
a) Year of Passing in class 12th *
b) Year of Passing in class 10th *
c) School Board of class 12th*
13. JEE (Main) 2017 Details (Same as per JEE-AdmitCard-2017) : *
a) JEE Application Number *
b) JEE Roll Number *
c) Category *