Application for College/Institute (Affiliated to Barkatullah University) KIOSK
First Name
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Middle Name
Last Name
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Gender
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Male
Female
Father/Husband Name
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Date of Birth(DD/MM/YYYY)
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State
*
Select
Madhya Pradesh
Chhattisgarh
Division
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District
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Tehsil
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Locality
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Rural
Urban
Block
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Gram Panchayat
*
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City/Village
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Pincode
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Residence Address
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Email
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Phone No.
Mobile No.
*
Aadhar No.
Qualification
*
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High School (10th)
Higher Secondary (12th)
Graduate
Post Graduate
Residence Proof
*
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Aadhaar Card
Central/State Govt. issued ID
Driving License
Passport
Passport Number
Ration Card
Voter ID Card
Water Bill
Please tick if College/Institute address is same as applicant's residence address
College/Institute Name
*
State
*
Select
Madhya Pradesh
Chhattisgarh
Division
*
Select
District
*
Select
Tehsil
*
Select
Locality
*
Rural
Urban
Block
*
Select
Gram Panchayat
*
Select
City/Village
*
Select
Pincode
*
Phone No.
Mobile No.
*
Fax No.
College/Institute Address
*
Landmark close by
*
College/Institute Address Proof
*
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Electricity Bill(Last or Current Month Only)
Telephone Bill(Last or Current Month Only)
Internet Connection Type
*
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Wireless-BroadBand
Wired-BroadBand
No. of Computer's
*
No. of Printer's
*
No. of Scanner's
*
No. of Camera's
*
No. of Computer Operator's
*
Conversant in Typing & Reading
*
Hindi
English
घोषणा
मैं एतद् द्वारा घोषणा करता/करती हूं कि मैंने दिए गए समस्त नियम एवं दिशा-निर्देशों को पढ़कर समझ लिया है एवं मेरे द्वारा एमपीऑनलाइन अधिकृत कियोस्क आवंटन हेतु आवेदन फार्म में भरी गई समस्त जानकारियां पूर्णतः सत्य हैं। यदि कोई जानकारी गलत पाई जाती है और उस आधार पर मेरा आवेदन निरस्त किया जाता है तो उसकी समस्त जवाबदारी स्वयं मेरी होगी।