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4/29/2016

IUET

IntegralUniversityEntranceTest(IUET2016)
RegistraonForm
CourseApplied

B.P.Th.

Papers

NA

FormNumber

2016012172

RollNumber

NotApplicable

PersonalDetails

Name

SHAMAPARVEEN

Gender

Female

DateofBirth

30/09/1999

PlaceofBirth

AZAMGARH

Domicile

UTTARPRADESH

Naonality

Indian

BloodGroup

NotKnown

Religion

Muslim

Mobile

8057559003

Landline

PhysicallyHandicapped

No

UploadPhoto

UploadSignature

Parents'Details

Father'sDetails:

Father's/Husband'sName

SHAHALAM

EducaonalQualicaon

8THSTANDARD

Occupaon

BUSINESS

Designaon

OWNER

OrganizaonName

SHAHEENTEXTILES

Father'sContactNo.
(Landline)

Father'sContactNo.
(Mobile)

9889070450

Father'sEmailAddress

Mother'sDetails:

http://iuet.iul.ac.in/PrintApplication.aspx?email=azmiamh1993@gmail.com&formnumber=2016012172

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Mother'sName

SUFIYANABANO

EducaonalQualicaon

Occupaon

HOMEMAKER

Designaon

OrganizaonName

8THSTANDARD

Mother'sContactNo.
(Landline)

Mother'sContactNo.
(Mobile)

9889070440

Mother'sEmailAddress

FamilyIncome

1to5Lacs

ContactDetails

ResidenceStatus

City/Town

CurrentAddress

SHAHEENTEXTILES
POSTLALGANJ

PermanentAddress

SHAHEENTEXTILES
POSTLALGANJ

CurrentState

UttarPradesh

PermanentState

UttarPradesh

CurrentCity

Azamgarh

PermanentCity

Azamgarh

CurrentPincode

276202

PermanentPincode

276202

OtherInformaons

CampusAppliedfor

LucknowCampus

HostelAccommodaon
required

Yes

QualifyingExam.Details

HighSchool:

Exam.Name

HighSchool

RollNumber

3132674

Board/University

UPBOARD

SchoolName

NAZMAGIRLSHIGHSCHOOLDAUNALALGANJAZAMGARH
SchoolCity

ObtainedMarks

451

MaxMarks

600

Percentage

75.2

YearofPassing

2014

Intermediate/Diploma:

http://iuet.iul.ac.in/PrintApplication.aspx?email=azmiamh1993@gmail.com&formnumber=2016012172

AZAMGARH

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Exam.Name

Intermediate

RollNumber

2385926

SchoolName

NAZMAGIRLSINTERCOLLEGEDAUNALALGANJAZAMGARH
SchoolCity

ObtainedMarks

N/A

MaxMarks

N/A

Percentage

N/A

YearofPassing

2016

Graduaon:

Exam.Name

N/A

Board/University

RollNumber

Board/University

School/CollegeName

School/CollegeCity

ObtainedMarks

MaxMarks

Percentage

YearofPassing

PostGraduaon:

Exam.Name

N/A

RollNumber

Board/University

School/CollegeName

School/CollegeCity

ObtainedMarks

MaxMarks

Percentage

YearofPassing

QualifyingExamStatus

Appearing

UPBOARD

AZAMGARH

Subjectsin10+2

PCB

MiscellaneousInformaon

Howdidyougettoknow
aboutIntegralUniversity

Friends

Isanyofyourfamily
memberassociatedwith
IntegralUniversity

None

Nameofthefamilymember

Course(IfStudent/Alumni)/
Designaon(Ifemployee)

Duraon
Haveyoupreviouslyapplied

http://iuet.iul.ac.in/PrintApplication.aspx?email=azmiamh1993@gmail.com&formnumber=2016012172

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IUET

foradmissiontoIntegral
University?
Coursepreviouslyapplied
for

PreviousFormNo.

Year

Wereyouselected?

No

2015IntegralUniversity

http://iuet.iul.ac.in/PrintApplication.aspx?email=azmiamh1993@gmail.com&formnumber=2016012172

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