Personal
Details
Name
:
Guest
Date Of Birth
:
Sex
:
Marital Status
:
Category
:
Select Category Gen OBC SC ST
Nationality
(If Other Than Indian)
:
Domisile State
:
[Select State] Andaman and Nicobar
(UT) Arunachal Pradesh Assam Bihar Chhattisgarh Goa Gujarat Haryana Himachal Pradesh Jammu &
Kashmir Jharkhand Karnataka Kerala Madhya Pradesh Maharashtra
Manipur Meghalaya
Mizoram Nagaland
Orissa Punjab
Rajasthan Sikkim
Tamil Nadu Tripura
Uttar Pradesh Uttaranchal West Bengal
Delhi Andhra
Pradesh Chandigarh (UT) Dadra and Nagar Haveli (UT) Daman and
Diu (UT) Lakshadweep (UT) Pondicherry (UT)
Correspondance Address
Address Line 1
:
Address Line 2
:
City
:
State
:
[Select State] Andaman and Nicobar
(UT) Arunachal Pradesh Assam Bihar Chhattisgarh Goa Gujarat Haryana Himachal Pradesh Jammu &
Kashmir Jharkhand Karnataka Kerala Madhya Pradesh Maharashtra
Manipur Meghalaya
Mizoram Nagaland
Orissa Punjab
Rajasthan Sikkim
Tamil Nadu Tripura
Uttar Pradesh Uttaranchal West Bengal
Delhi Andhra
Pradesh Chandigarh (UT) Dadra and Nagar Haveli (UT) Daman and
Diu (UT) Lakshadweep (UT) Pondicherry (UT)
Pin
:
Phone
:
Fax
:
Permanent Address
:
Same as Correspondance
Address
Address Line 1
:
Address Line 2
:
City
:
State
:
[Select State] Andaman and Nicobar
(UT) Arunachal Pradesh Assam Bihar Chhattisgarh Goa Gujarat Haryana Himachal Pradesh Jammu &
Kashmir Jharkhand Karnataka Kerala Madhya Pradesh Maharashtra
Manipur Meghalaya
Mizoram Nagaland
Orissa Punjab
Rajasthan Sikkim
Tamil Nadu Tripura
Uttar Pradesh Uttaranchal West Bengal
Delhi Andhra
Pradesh Chandigarh (UT) Dadra and Nagar Haveli (UT) Daman and
Diu (UT) Lakshadweep (UT) Pondicherry (UT)
Pin
:
Phone
:
Fax
:
Emergency Contact No
:
Emergency Contact Person
:
Relation With Contact Person
:
Your Mobile Number(s)
:
Your (Amity) e-Mail
:
Confirm Your e-Mail
:
Your (Non Amity) e-Mail
:
Please give the e-Mail which you regularly
check
Confirm Your e-Mail
:
:
Do You have Driving Licence
:
Driving Licence Number
:
Do You have Passport
:
Passport Number
:
How Do You Commute to Campus?
:
[Select Commute to Campus] Own Vehicle (Car) Own Vehicle (Two
Wheeler) Car Pool Amity Vehicle Public Transport
Charted Vehicle
Vehicle Registration No (If Applicable)
: