Please enable JavaScript in your browser to complete this form.Roll NoName of coursesESPDESPDMSD11-12th classesB.com/B.sc classesSSC/BankRailway/DefenceNameGenderMaleFemaleOthersDate of BirthAgeIn WordsFather's/Husband's NameContact No.Mother's NameContact No.Local Guardian's NameContact No.Family's Annual IncomeLocal AddressPin CodePhone No.Email *Mobile No.Permanent AddressPin CodePhone No.Course Apply forIdentification MarkBoard/UniversityMatric/Higher Secondary(X)Intermediate/Senior Secondary(XII)GraduationPost -GraduationIf Any otherYear of passingSubjects StudiedDivision (with % age)DelcarationI hereby, declare that the information given in the form is true to the best of my knowledge and belief. I undertake to accept and abide by the rules of Xcellence Valley and all the decisions of the admission committee in regard to any admission. I further declare that I am not involved in any criminal case and / or no such case is pending against me in any court of law.Submit