Khentawas, Farrukhnagar, Gurgaon-123506 (Haryana)
 
APPLICATION FORM FOR ADMISSION TO B.TECH/M.TECH.         (SESSION 2016-2017)
 
Instructions :
 
1. Please read Information Brochure carefully before filling each items of Application Form.
2. No column should be left blank, write N.A. if not applicable.
 
 
Roll No.
Rank
 JEE (Main)
  12th Class
  All India Rank
  State All India Rank
 
B.Tech Applied For
M.Tech Applied For

 
Name
           
 
Date of Birth
Nationality    
 
Father's Name
Qualification
Designation
Occupation
Mother's Name
Qualification
Designation
Occupation
 
Category  
 
Permanent Address   Postal Address
     
  Address
 
  State
  Pin Code
  STD Code
  Phone No.
  Mobile No.
  E-Mail ID
 
  Address
 
  State
  Pin Code
  STD Code
  Phone No.
  Mobile No.
  E-Mail ID
 
Educational Qualification
 
 
Passing
Year
Board / University Marks
Obtained
Maximum
Marks
% age   Division
 
10 th
%
   
12 th
%
   
Diploma
%
   
Degree
%
   
Other
%
 
Date : 19/1/2017
   
Declaration : Certified that all entries in this form are correct.