University roll no*

College icard no*

Course*

Name of student*

Father name*

Mother name*

Mobile number*

Email address*

Date of birth*

Year*

Semester*

Gender*

Renew your icard*

Present address*

Pincode*

Sem/Year	Status	Marks Obtained
I Sem/Year
II Sem/Year
III Sem/Year
IV Sem/Year

Photograph*

* file size should not be more than 100kb

Signature*

* file size should not be more than 50kb

Captcha*