Student Full Name *

Date of Birth *

Father's Name *

Mother's Name *

Year / Semester *
Select Year1st Year2nd Year3rd Year4th YearWorking Professional

Blood Group *
SelectA+A-B+B-AB+AB-O+O-

Room Type *
Select Room2 Sharing Room3 Sharing RoomAttached Bathroom

Preferred Location *
Select LocationVanraji Society — MIT College RoadGirija Society — Paud RoadSavali Society — MIT Back RoadAny Available

Move-In Date *

Mobile Number *

Alternate Contact Number

Email Address *

Student Photo *

Aadhar Card Number *

PAN Card Number

Aadhar Card Copy *

College ID / Offer Letter

Guardian Name *

Relation with Student *
SelectFatherMotherBrotherSisterUncleOther

Guardian Contact Number *

Guardian Aadhar Number

Guardian ID Proof *

Parent / Guardian Digital Signature *