Online Registration Application Form

1. Application No :*

2. Upload Photo :*

Note : Please upload recent passport size photo within 50 kb.

3. Name Of the Aplicant :*

4. Gender :*

Male Female

5. Email :

6. Fathers Name:*

7. Date Of Birth:*

8. Dist:*

9. Name Of Bolck:*

10. Name Of School:*

11. Mobile No:*

12. Other Mobile No:

13. Address :

14. Post:*

15. District:*

16. Mode of Payment:*

17. Money Order Receipt No:*

18. Money Order Date:*

19. Signeture: *

Note : Please upload signeture within 50 kb.

Code :*

(Please Enter the code in the box)

Bidyabharati Residential School , Balangir