8/17/2019 IUET Shama

1/4

4/29/2016 IUET

http://i uet.i ul .ac.i n/Pr intAppl icati on.aspx?em ai l= azm iam h1993@gm ai l.com &for mnum ber =2016012172

Integral University Entrance Test (IUET ‐ 2016)

Registraĕon Form

Course Applied   B.P.Th.   Papers   NA

Form Number   2016012172   Roll Number   Not Applicable

Personal Details

Name   SHAMA PARVEEN   Gender   Female

Date of Birth   30/09/1999   Place of Birth   AZAMGARH

Domicile   UTTAR PRADESH   Naĕonality   Indian

Blood Group   Not Known   Religion   Muslim

Mobile   8057559003   Landline

Physically Handicapped   No

Upload Photo Upload Signature

 

Parents' Details

Father's Details :‐

Father's/Husband's Name   SHAH ALAM   Educaĕonal Qualificaĕon   8TH STANDARD

Occupaĕon   BUSINESS   Designaĕon   OWNER

Organizaĕon Name   SHAHEEN TEXTILES   Father's Contact No.

(Landline)

Father's Contact No.

(Mobile)

9889070450   Father's E‐mail Address

Mother's Details :‐

8/17/2019 IUET Shama

2/4

4/29/2016 IUET

http://i uet.i ul .ac.i n/Pr intAppl icati on.aspx?em ai l= azm iam h1993@gm ai l.com &for mnum ber =2016012172

Mother's Name   SUFIYANA BANO   Educaĕonal Qualificaĕon   8TH STANDARD

Occupaĕon   HOMEMAKER   Designaĕon

Organizaĕon Name Mother's Contact No.

(Landline)

Mother's Contact No.

(Mobile)

9889070440   Mother's E‐mail Address

Family Income   1 to 5 Lacs

 

Contact Details

Residence Status   City/Town  

Current Address   SHAHEEN TEXTILESPOST LALGANJ

Permanent Address   SHAHEEN TEXTILESPOST LALGANJ

Current State   Uttar Pradesh   Permanent State   Uttar Pradesh

Current City   Azamgarh   Permanent City   Azamgarh

Current Pincode   276202   Permanent Pincode   276202

 

Other Informaĕons

Campus Applied for   Lucknow Campus  

Hostel Accommodaĕon

required

Yes

 

Qualifying Exam. Details

High School :‐  

Exam. Name   High School

Roll Number   3132674   Board/University   UP BOARD

School Name   NAZMA GIRLS HIGH SCHOOL DAUNA L School City   AZAMGARH

Obtained Marks   451   Max Marks   600

Percentage   75.2   Year of Passing   2014

Intermediate/Diploma :‐  

8/17/2019 IUET Shama

3/4

4/29/2016 IUET

http://i uet.i ul .ac.i n/Pr intAppl icati on.aspx?em ai l= azm iam h1993@gm ai l.com &for mnum ber =2016012172

Exam. Name   Intermediate

Roll Number   2385926   Board/University   UP BOARD

School Name   NAZMA GIRLS INTER COLLEGE DAUN School City   AZAMGARH

Obtained Marks   N/A   Max Marks   N/A

Percentage   N/A   Year of Passing   2016

Graduaĕon :‐  

Exam. Name   N/A

Roll Number Board/University

School/College Name School/College City

Obtained Marks Max Marks

Percentage Year of Passing

Post Graduaĕon :‐  

Exam. Name   N/A

Roll Number Board/University

School/College Name School/College City

Obtained Marks Max Marks

Percentage Year of Passing

Qualifying Exam Status   Appearing   Subjects in 10+2   PCB

 

Miscellaneous Informaĕon

How did you get to know

about Integral University

Friends   Is any of your family

member associated with

Integral University

None

Name of the family member Course(If Student/Alumni) /

Designaĕon (If employee)

Duraĕon

Have you previously applied

8/17/2019 IUET Shama

4/4

4/29/2016 IUET

http://i uet.i ul .ac.i n/Pr intAppl icati on.aspx?em ai l= azm iam h1993@gm ai l.com &for mnum ber =2016012172

for admission to Integral

University?

Course previously applied

for

Previous Form No.

Year Were you selected?   No

 

© 2015 Integral Univers