MJPTBCWREIS Backlog-2025 Application Form

Payment Gateway Through Credit Card / Debit Card :

PAYMENT OF APPLICATION FEE Rs.100/-

Sur Name : *

Name of the Student : *

Gender *

Male Female

Whether the Annual Income of Parent is below Rs.1.5 Lakh (Rural) / 2 Lakh (Urban) *

Yes No

Annual Income : *

Select District: *

Admission Into : *

Caste Category*

Select Sub Caste*

Student Aadhaar No.* : : *

Contact Number : *

Email :

Date of Birth : *

Age : *