SH24 Gaya-Patna Main Road,Hulasganj,Jehanabad, Bihar - 804407
Phone: +91 911 011 7517
Website : www.lkpbedcollege.in | Email : ask@lkpbedcollege.in

APPLICATION FORM

(To Be Filled in Block Letters)

S.NO._______________

BATCH 2019-21

FOR OFFICE USE ONLY

Enrollment No...........................................................

Fee Paid Rs...................................

Receipt No...................................................................

Date.................................................

1.Personal Details

First Name

Middle Name

Last Name

Date Of Birth(DD-MM-YYYY)

Email ID

Mobile No.

Category (GEN / OBC / SC / ST / PH)

Religion

Aadhar Number

Correspondence Address

City

State

Pin code

Permanent Address

City

State

Pin code

Father's Name

Occupation

Mob. No.

Mother's Name

Occupation

Mob. No.

Father's / Mother's Email Id

Family Annual Income Rs.

2. Academic Record

Exam. Passed	Board / University	School / College / Institute (With Location)	Degree / Specializations	Year Of Passing	Marks % / CGPA	Medium Of Education
10th
12th
Graduation
Any Other Specify

3. Entrance Examinations

Name of Entrance Examination	Exam Registration No.	Exam Month & Year	Score	Percentile

4. References of two persons who know you well [Relatives/College Professors/Work Supervisors]

Name	Relatives/Professors/Supervisors	Address	Phone	Email ID

5. Why do you want to Join LKP College ? (3 Points)

6. Do you Require Hostel Accommodation ?

YesNo

I declare that the information furnished above is correct. I Accept that incorrect information or withholding of relevant information may disqualify me.
I agree to abide by the rules and regulations of the Institute.