User Registration Form

Personal Details

Name Of Applicant

Email :

Gender:

--Select-- Male Female

Phone Number :

Mobile Number :

Nationality

Address :

Taluka

Village :

District :

State :

Pincode :

Grievance Details

Grievance Category * :

--Select-- Employee Student Alumni Parents

Grievance Type :

--Select-- Institutional Departmental Personal Hostel

Last complaint resolved ? ,if any

Yes    No    No Previous Grievances

Grievance Details

Branch

--Select-- Mechanical Civil Electrical Computer Electronics and TeleComm

Session of Admission :

Enrollment No.

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Grievance Redressal