|
Personal Details |
| BITS
Identity Number (IDNO) |
|
Student
Name: (As it appears in BITS Diploma / Degree certificate) |
|
| Father's
Name
(As it
appears in Secondary Certificate) |
|
| Mother's
Name
|
|
| Sex: |
|
| Date of
Birth (As it
appears in Secondary Certificate)
|
|
| Diploma /
Degree Name |
|
Phone Numbers (Country Code-Area Code-Number) |
(Office): |
|
(Residence): |
| Fax:: |
|
| Mobile: |
|
| E-Mail (Only one valid
E-Mail Id): |
|
| |
|
|
Complete Postal Address |
| Postal Address |
Line1: |
|
Line2: |
|
Line3: |
| City: |
|
| State: |
|
| Pin code: |
|
| Country |
|
| |
|
| Migration Certificate
Charges |
Rs. 300/- |
|
Mode of Post
|
Charges :
|
| |
|
Total Amount Payable (Migration
certificate plus postal charges)
|
| |
| Note ::
|
Please
ensure that the details provided by you are correct and complete. |
Please
specify only one email id (Preferably
give your personal Email Id).
|