Nexgen Education

College/ Institute Name

Institute Photo (File must be type of jpg, png, jpeg (Max Size : 4MB))

First Name*

Last Name

Email Address*

Phone Number*

Street Address*

City*

State*

Country*

Zip Code*

Aadhar card no.*

Upload Aadhar Front* (File must be type of jpg, png, jpeg (Max Size : 4MB))

Upload Aadhar Back* (File must be type of jpg, png, jpeg (Max Size : 4MB))

PAN no.* (File must be type of jpg, png, jpeg (Max Size : 4MB))

Upload Pan* (File must be type of jpg, png, jpeg (Max Size : 4MB))

Bank Name*

Branch*

Account No.*

IFSC Code*

Bank Proof* (File must be type of jpg, png, jpeg (Max Size : 4MB))

Coordinator Photograph* (File must be type of jpg, png, jpeg (Max Size : 4MB))

Registration (Any Government Reg.)

Government Reg. Photo (File must be type of jpg, png, jpeg (Max Size : 4MB))