Placement Registration Form

Paste your
Session 2017-18
photo here

(1) Name: _______________________________________________________

(2) Email ID: ______________________________ Mobile No.: ____________

(3) Gender: Male Female

(4) Date of Birth: _______/____________/_______________

(5) Degree: _____________________________________________________

(6) Department: _________________________________________________

(7) Address for Correspondence:

___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

I hereby declare that the information provided by me is true and subject to verification by
Manipal University Jaipur. I understand that any false information given by me in this
application form will render me unconditionally liable for termination from any placement
assistance from Manipal University Jaipur. I have read and fully understood the placement
rules and regulations.

Date____/_______/_______ Place______________ Signature_____________