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Personal Details
Salutation * : First Name * :
Middle name : Last Name * :
Date of Birth * :
Age (as on 29 July, 2010) * : Gender * :
Nationality * : Marital Status * :
Name of Father/Mother/Guardian * : Occupation of Father/Mother/Guardian :
Academic Qualification of Father/Mother/Guardian :
Present Address
Address Line 1 * : Address Line 2 : Address Line 3 :
City * : State * :
Pincode * : STD code * :
Phone Number * : Fax :
Mobile Number : Primary Email * :
Retype Primary Email * : Alternate Email * :
Retype Alternate Email * : Is Permanent address same as Present ? * :
Indicate your Choice of centre for the MICAT
Test City * :
Other Details
How did you come to know about MICA (Press and hold Ctrl key for multiple select) : If others, Mention How did you come to know about MICA :
In what publication did you read the MICA admissions announcement? (Press and hold Ctrl key for multiple select) : If others, please specify MICA admissions announcement :
Please Select/mention the other Management entrance examination(s) you have appeared in 2010-2011 (Press and hold Ctrl key for multiple select) * : If any other, please specify Examination Name :
Annual Income of Parents (Individually or combined)/ Guardian :

 
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