Surname * (Only Surname)

First Name * (Only Name Without Surname)

Father's First Name * (Only Name Without Surname)

Mother's First Name (as per 12^th marksheet)* (Only Name Without Surname)

Student Email Id *

Student Mobile Number *

Adhaar Number * (Enter 12 digit Aadhar number without any space or dash)

Gender * Male Female Transgender

Date of Birth: (DD-MM-YYYY) *

NEET Seat No *

NEET Application ID *

Total Neet Attempt's *

12^th Percentage

Name of the 12^th High School/ College : *

12^th High School/College District * Ahmednagar Akola Amravati Aurangabad Beed Bhandara Buldhana Chandrapur Dhule Gadchiroli Gondia Hingoli Jalgaon Jalna Kolhapur Latur Mumbai City Mumbai Suburban Nagpur Nanded Nandurbar Nashik Osmanabad Palghar Parbhani Pune Raigad Ratnagiri Sangli Satara Sindhudurg Solapur Thane Wardha Washim Yavatmal Other

Caste : *

Category: * EWS NTA-VJ NTB-NT1 NTC-NT2 NTD-NT3 OBC SBC SC SEBC ST UNRESERVED

Are you from Special Reservation? * NO HILLY AREA DEFENCE CHILD PH

Permanent Address * (Allowed characters: letters, numbers, dash and comma)