Online Enrollment Form

ONLINE ENROLLMENT FORM

To ensure the smooth processing of your enrollment please provide us with accurate information below.

At Logiquest, we uphold a very strict data privacy policy. Your personal information will remain confidential and will not be shared with anyone. Rest assured that your details will be saved securely with us.

First Name *

Last Name *

Registered Email *

Country Code *

Registered Number *

Date of Birth *

College

Course interested in *

Select year of MBBS study *

State of Residence *

Year of Graduation

Parent Name *

Parent / Guardian Mobile *

Parent / Guardian Alternate Number

Parent / Guardian email id

Correspondence Address

Permanent Address *

Please Type SAME AS ABOVE incase your correspondence address and permanent address is same

I agree to the Terms and Conditions

Click here for detailed Terms and Conditions

Picture Upload *

Upload a Png or Jpeg maximum 5 mb

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