AMITY CHENNAI

STUDENT INFORMATION FORM

Instructions: 1. Kindly fill all the details in CAPITAL LETTERS.
2. Fill the names (STUDENT’S NAME, FATHER’S NAME and MOTHER’S NAMEs) as per your
10th mark sheet.

Adh
STUDENT NAME

DATE OF BIRTH

REGISTRATION NO

COURSE
CONTACT NO
(STUDENT)
EMAIL-ID (STUDENT)

BLOOD GROUP
COMMUNICATION PERMANENT

ADDRESS

MOTHER'S
FATHER'S NAME
NAME

OCCUPATION OCCUPATION

CONTACT NO CONTACT NO

EMAIL-ID EMAIL-ID

EMERGENCY
NAME: MOB: RELATION:
CONTACT

LOCAL GUARDIAN (LG) DETAILS (If applicable) HOSTEL DETAILS (If applicable)

NAME OF THE LG HOSTEL NAME

RELATIONSHIP WITH CONTACT
THE STUDENT PERSON NAME

ADDRESS ADDRESS

CONTACT NO CONTACT NO

I hereby declare that the above given information are true to the best of my knowledge and also I know that
Amity Chennai may contact us through the above given details for communication.

Student Sign: Local Guardian Sign: Parent’s Sign:

Date: Date: Date: