Application Form

PROGRAM SELECTION (Note: Program selection cannot be edited after submisson.)

Applying for Program*
--Select-- MBBS IT Education Country *
--Select-- China India University *
--Select-- Select Bissav Branch *
--Select-- Hajipur Branch Patna Branch

PERSONAL INFORMATION

First Name *
Last Name
Date of Birth
Passport
--Select-- Available Applied for Yet to apply

Passport No

Passport Expiry Date
Native Language
Place of Birth
Religion
Nationality
--Select-- Indian Others Category
--Select-- GEN OBC SC ST Other Marital Status
--Select-- Married Unmarried Did you ever study in Abroad before?
--Select-- Yes No

Country name

Foreign language study?
--Select-- Yes No

Language name

Flat no./Building Name
Area
Street Name
City
Pin code
Country

Contact Information

Mobile Number 1 *
Mobile Number 2
Email ID *
Whatsapp Number

Parents Information

Father Name
Father Age
Father Mobile No
Mother Name
Mother Age
Mother Mobile No

FINANCIAL INFORMATION

Father Occupation
--Select-- Working Self Employed Retired Other Education Loan required?

Yes

No

Filing ITR / Provide Form 16?

Yes

No

Anual Income
Mother Occupation
--Select-- Working Self Employed Retired Other Education Loan required?

Yes

No

Filing ITR / Provide Form 16?

Yes

No

Anual Income