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Counselling (non-refundable) fee of Rs. 500/- to be paid in the form of Bank Draft to be drawn in favour of Central Selection Committee (E&T)payable at Kolkata and to be deposited in the bank counter opened at the venue of counselling.

CENTRAL SELECTION COMMITTEE (ENGG & TECH)


COUNSELLING FORM (Engg & Tech) for JEM 2011
AIEEE Enrolment No. AIEEE RANK (if any)

JEM Enrolment No.

Copy of a recent passport size photo of the applicant to be pasted & attested by a responsible person within this box.

JEM Rank in
GEN

All India Rank


(OVERALL)

Whether cleared NATA (Please Tick)


YES NO

ENGG. S.C & TECH. S.T

Whether domiciled in West Bengal (Please Tick)

YES
BIO (B) PHY (P)

NO
CHEM (C) MATH (M)

NATA SCORE

Marks obtained in H.S (10+2) or equivalent exam.


% (PCM)

% (PCB)

ENGLISH

VERNACULAR /5th SUBJECT

Date of Birth DD MM YY

Full Marks

Marks Obtained

Name of the Applicant (IN BLOCK LETTER) First Name Middle Name (If Any) Surname
Fathers /Mothers/ *Guardians Name

(* if father and mother are not alive)

Mailing address

Pin Code

Tele Phone Number

I declare that the statement given above are true to the best of my knowledge Counter Signature of Parent / Guardian in full Signature of the candidate in full

DECLARATION

( To be ticked by the verifying officer )

Eligible for admission to

(For office use only)


B.Arch

BE / B Tech./ B Phram

BE / B Tech./B. Pharm/

Only B. Pharm

SPACE FOR OFFICIAL STAMP The following allotment code is the option exercised by me based on the availability of seats at the instant of my counselling. I will not claim any other seat in future. I understand that if I do not take admission to the allotted college / Institution within stipulated time, my allotment shall stand cancelled. ALLOTMENT CODE ....................................... Signature of the Candidate in Full

Please bring one copy of this counselling form duly filled in and signed before appearing in the counselling PLEASE ALSO DOWNLOAD IMPORTANT INFORMATION PERTAINING TO COUNSELLING

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