📍 Barahi, Bithan, Samastipur, Bihar (848207) | 📞 +91 9122348878 | ✉️ imtiyajhasan@2018@gmail.com

Hostel Application Form

Student Details

Full Name *

Class / Course *

Roll No / Student ID

Date of Birth *

Gender *

Blood Group

Parent / Guardian Details

Father's Name *

Mother's Name *

Emergency Mobile Number *

+91

Email Address

Permanent Address *

Declaration

I declare that all the information provided above is absolutely correct.

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