Online Application :: Admission :: Vimal Jyothi Institute of Management and Research :: Approved by AICTE and Affiliated to Kannur University

ID/Reg. No / Roll No:

Composite Score / Percentile:

Full Name:

Date of Birth:

Gender: Male Female

Marital Status: Unmarried Married

Category: General OBC SC ST

Nationality: Indian Other Aadhar No:

Religion: Hindu Christian Muslim Others

If Catholic, Name of your parish:

If Catholic, Name of your Diocese:

Mother Tongue: Malayalam Other

Do you plan to avail an education loan for the course?: Yes No

Address for Correspondence:

Pincode:

Permanent Address:

Pincode:

Email:

Land Phone:

Mobile:

Father’s Name:

Father’s Occupation:

Mobile:

Mother’s Name:

Mother’s Occupation:

Mobile:

Blood Group:

Height (In cm):

Weight (In Kg):

Total Annual Household Income(gross):

Local guardian
(Mr/Ms):

Mobile:

Relationship with you:

If you have participated in any sports/games at State/National level, give details: State National

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