Application form for LURN * denotes mandatory fields

Student's Details

First Name *

Middle Name

Last Name

Date of Birth *

Email ID *

Mobile Number (10 digits) *

Father's Details

First Name *

Middle Name

Last Name

Mother's Details

First Name *

Middle Name

Last Name

Personal Details

Gender *

Male

Female

Transgender

Domicile *

Others

Caste *

Caste Certificate Number *

Nationality *

Religion *

Blood Group

ID Proof *

ID Proof No.*

Aadhaar Card Number *

EWS

Address for Correspondence

Address *

Country *

State / Union Territory *

District *

PIN Code *

Alternate Mobile Number (10 digits)

Click if Permanent Address is same as Correspondence Address

Permanent Address

Address *

Country *

State / Union Territory *

District *

PIN Code *

Alternate Mobile Number (10 digits)

I hereby declare that the above filled information is true and correct to the best of my knowledge. I understand that if any of the furnished information is found to be false or untrue then I shall be solely held responsible for the same and University will hold the rights to cancel my application.