Application for CIEAT-2019
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Fields marked with* are mandatory.

 
Personal Details
*Salutation
*Full Name

Please enter your Full name as per your qualifying examination certificate. Do not
 repeat the salutation. Leave one space before initials Ex: Abdur Rahman. B. S
*Gender *Date of Birth(DD/MM/YYYY)
*Religion *Community
*Mother Tongue
Aadhaar Card Number

Parents Details
 
*Name of the Father *Occupation of Father
Father's Mobile Number
*Name of the Mother *Occupation of Mother
Mother's Mobile Number

Course Preference
 
*Program First Preference
Second Preference Third Preference
Choice of Test City
 
*Please choose a city to appear for CIEAT-2019 test


Address For Communication
*Address Line 1 *Address Line 2
Address Line 3 *Country
*State
*City
*Pincode Phone No (with STD code)
*Mobile No *Email ID

 
Qualification Details
 
*Qualifying Examination Register No.
*Medium of Instruction
*Year and Month of Passing/Appearing
*Name & Address of the School last studied

Marks Obtained in the Qualifying Examination

Note: 1. Marks should be entered once the +2 exam results are published.
2. Candidates applying to Biotechnology should enter marks in Biology.
*Enter the marks if available Yes No



Upload Photo
 
*Please Upload your Photo Upload here  
 
Payment Details
*Payment Mode
I would like to contribute Rs.50/- for the education of unprivileged students
Total Amount (in Rupees) /-


Declaration
 

I hereby certify that the information given by me in this Application Form is true to the best of my knowledge.

 
    I Agree

INSTRUCTIONS

    Please navigate to Test Details Tab to enter your test centre choice.
Version 13.06.01