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Dr. A. M. Pradhan Commerce & Arts College
Vaccination Details & Consent
* Indicates required question
Full Name of the Student (Incl. Father & Mother's Name
*
Surname - Student's Name - Father's Name - Mother's Name
Your answer
E - Mail id of Student
*
Valid Mail id of Student
Your answer
Mobile Number of Student ( Preferably Whatapp No.
*
10 digit Mobile number
Your answer
Mobile Number of Parent / Guardian ( Preferably Whatapp No.
*
10 digit Mobile number
Your answer
Address
*
Residential Address
Your answer
Class
*
Your Class
FYBcom
SYBcom
Roll No.
*
Enter Roll Number
Your answer
Date of Birth
*
Enter your Date of Birth
MM
/
DD
/
YYYY
Age
*
Year - Months
Your answer
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