GAUTAM BUDDH TECHNICAL UNIVERSITY, LUCKNOW

(Formerly Uttar Pradesh Technical University, Lucknow)

APPLICATION FORM FOR ADMISSION TO M.TECH./M.PHARM.
PROGRAMME
CHECKLIST
(Tick the Enclosed Documents. Please enclose only attested
COPIES. Please refer to the ADMISSION PROCEDURE for bringing
along the ORIGINALS for verification. Wherever applicable, mention
the CERTIFICATE NO. as prescribed in ADMISSION PROCEDURE)

Sl No Tick Particulars
1* Print out of On-Line Application Form (with photograph)
2* Demand Draft of Rs 1000=00 (or Rs 500=00) in favour of The Finance
Officer, Gautam Buddh Technical University, Lucknow payable at
Lucknow.
3* Date of Birth Certificate or the High Scool (class X) Certificate with Date of
Birth.
4* SC/ST/OBC/PH/DOMICILE etc certificates (all those are applicable).
5* Copies of degrees, marks/grade sheets of all the examinations passed.
6* Medical Certificate
7 Copy of GATE SCORE (if available)
8 No Objection Certificate from the employer (for employed applicants).
9 Copies of publications (if applicable).
Total No. of Enclosures : . No. of Sheets :
* : Required

Signature

Name






GAUTAM BUDDH TECHNICAL UNIVERSITY, LUCKNOW
(Formerly Uttar Pradesh Technical University, Lucknow)
M. TECH. and M. PHARM. PROGRAMME
ADMISSION PROCEDURE
1. ADMISSIONS

1.1 Gautam Buddh Technical University, Lucknow (Formerly Uttar Pradesh
Technical University (UPTU), Lucknow) coordinates and awards post
graduate masters degree leading to Master of Technology (M. Tech.)
and Master of Pharmacy (M. Pharm.) Degrees in certain fields of
specialization. The programmes are conducted at various institutions
approved by University from time to time.
1.2 The process of admissions to the M. Tech. and M. Pharm.
programme is centrally coordinated by the University for all the fields
of specialization and for all the institutions listed in section 2.
1.3 Reservation in admission shall be governed by the U.P. State Govt.
rules. In case of non-availability of suitable candidates in any category,
the decision of University for filling up vacant seats shall be final.

2. COURSES OFFERED

2.1 M. Tech. Programme/ Institutions/ Intake
(i) Govt. / Govt. Aided Institutions
Institute
Code
Name of the
Institution
Stream of
Engineering/
Technology
Specialization of M. Tech.
Programme
Intake
042 M.M.M. Engineering
College, Gorakhpur
Civil 1. Environmental Engineering 18
Civil 2. Hill Area Development Engineering 18
Civil 3. Seismic Design & Earthquake
Engineering
18
Civil 4. Structural Engineering 18
Electrical 5. Power Electronics and Drives 18
Electronics 6. Digital Systems 18
Mechanical 7. Computer Integrated Manufacturing 18
Computer
Science
8. Computer Science and Engineering 18

043 Bundelkhand Institute
of Engineering &
Technology, J hansi.
Electronics 1. Digital Communications 20
Civil 2. Construction Technology &
Management
18
Mechanical 3. Manufacturing Science & Technology 18
Civil 4. Environmental Engineering 18
044 Uttar Pradesh Textile
Technology Institute,
Kanpur.
Textile 1. Textile Technology 18
Textile 2. Textile Chemistry 12
045 Harcourt Butler
Technological Institute,
Kanpur
Chemical 1. Chemical Technology with
specialization in Bio-Chemical
Engineering/ Food Technology/ Oil
Technology
34
2. Chemical Engineering 18
Mechanical 3. Computer Aided Design 18
Electronics 4. Electronics & Communication
Engineering
18
052 Institute of Engineering
& Technology,
Lucknow.
Civil 1. Environmental Engineering 18
Bio-Technology
2. Bio-Technology 18
Electronics 3. Micro-Electronics 15
104 Kamla Nehru Institute
of Technology,
Sultanpur.
Electrical 1. Power Electronics & Drives 18
Mechanical 2. Thermal Engineering 18
Civil 3. Geotechnical & Environmental Engineering 18
Computer
Science
4. Computer Science & Engineering 18
190 DOEACC Centre,
Gorakhpur
Electronics 1. Electronics Design and Technology 18

(ii) Private Institutions
Institute
Code
Name of the
Institution
Stream of
Engineering
Specialization of M. Tech.
Programme
Intake
010 United College of
Engineering and
Research, Allahabad
Computer
Science
1. Computer Science & Engineering 18
014 Sri Rammurty Smarak
College of Engineering
& Technology, Bareilly
Inter-disciplinary 1. Computer Aided Design and Computer
Aided Manufacturing (CAD-CAM)
15
Computer
Science
2. Software Engineering 15
Electronics 3. Microwave Engineering 18
053 Azad Institute of
Engineering &
Technology, Lucknow
Mechanical 1. Advanced Computer Aided Design

18
Electronics 2. Electronics, Instrumentation & Control
Engineering
18

123 Saroj Institute of
Technology &
Management, Lucknow
Computer
Science
1. Computer Science & Engineering 18
Electronics 2. Electronics & Communication
Engineering
18
Electrical 3. Power Electronics 18
Mechanical 4. Thermal Engineering 18
138 B.B.S. College of
Engineering &
Technology, Allahabad
Mechanical 1. Advanced Computer Aided Design 18
145 College of Science &
Engineering, J hansi
Computer
Science
1. Computer Science & Engineering 18
Electronics 2. Electronics & Communication
Engineering
18
165 Kanpur Institute of
Technology, Kanpur
Computer
Science
1. Computer Science & Engineering 18
Electronics 2. Electronics & Communication
Engineering
18
Second Shift
053 Azad Institute of
Engineering &
Technology, Lucknow
Computer
Science
1. Computer Science & Engineering 18
Information
Technology
2. Information Technology 18

2.2 M. Pharm. Programmes / Institutions / Intake Private Institutions
Institut
e Code
Name of the Institution Specialization of M. Pharm.
Programme
Intake
041 Archarya Narendra Dev College of Pharmacy, Gonda 1. Pharmaceutical Chemistry 10
054 Babu Banarasi Das National Institute of
Technology & Management, Lucknow
1. Pharmaceutics 18
2. Pharmaceutical Chemistry 18
3. Pharmacognosy 10
056 Northern India Engineering College, Lucknow 1. Pharmaceutical Chemistry 10
123 Saroj Institute of Technology & Management,
Lucknow
1. Pharmaceutical Chemistry 18
2. Pharmacognosy 18
164 Pranveer Singh Institute of Technology,
Kanpur
1. Pharmaceutical Chemistry 18
2. Pharmaceutics 18
167 Rajarshi Rananjay Sinh College of Pharmacy,
Amethi, Sultanpur
1. Pharmaceutics 18
186 Kamla Nehru Institute of Management &
Technology, Sultanpur
1. Pharmaceutical Chemistry 10
188 Advance Institute of Biotech & Paramedical
Sciences, Kanpur
1. Pharmaceutics 18
2. Pharmaceutical Chemistry 18
202 Hygia Institute of Pharmaceutical Education
and Research, Lucknow
1. Pharmacology 18
2. Pharmaceutics 18
203 Rameshwaram Institute of Technology & 1. Pharmacology 18
Management, Lucknow
2. Pharmaceutics 18
236 Sir Madan Lal Institute of Pharmacy, Etwah 1. Pharmaceutics 18
2. Pharmacology 18
Second Shift
197 Azad Institute of Pharmacy & Research,
Lucknow
1. Pharmaceutics 18
2. Pharmaceutical Chemistry 18

3. ELIGIBILITY CRITERIA:

3.1. The applicant for M. Tech./ M. Pharm. programmes must fulfill the
following criteria:

i. General/ OBC candidates, with 60 % marks in graduation in Engineering
or Technology/ B. Pharm. or equivalent, are eligible.

ii. SC/ST candidates, with 55 % marks in graduation in Engineering or
Technology / B.Pharm. or equivalent, are eligible.

iii. For admission to M.Tech. (Computer Science, Information
Technology and related branches), candidates having degree of
MCA, M.Sc.(Computer Science) or M.Sc. (Information Technology) with
at least 60% marks for General/OBC candidates and 55% marks for
SC/ST candidates are also eligible.

iv. For admission to M.Tech. (Electronics Engineering and related
branches), candidates having degree of M.Sc. (Electronics) with at
least 60% marks (for General/OBC candidates), and 55% marks
(for SC/ST candidates) are also eligible.

v. For admission to M.Tech. (Chemical Technology and related branches),
candidates having degree of M.Sc. (Chemistry) with at least 60% marks
(for General/OBC candidates), and 55% marks (for SC/ST candidates) are
also eligible.

vi. For admission to M.Tech. (Hill Area Development Engineering) /
M.Tech. (Environmental Engineering), B.Tech. /B.E. or equivalent in any
branch of engineering / technology OR B.Arch. or equivalent. OR M.Sc. in
any discipline or Masters degree in Mathematics / Geography with at least
60% marks (for General / OBC candidates), and 55% marks
(for SC/ST candidates) are also eligible.

Candidates not having Mathematics at Intermediate level shall be required
to compulsorily qualify a non-credit course on Mathematics of
Intermediate level in the first semester of M.Tech. programme.

vii. For admission to M.Tech.(Bio-Technology), candidates having degree of
M.Sc. in Physical /Chemical /Biological /Veterinary/ Agricultural Science or
Biotechnology or Bioinformatics or equivalent degree in relevant
disciplines or B.E. /B.Tech. in Chemical /Bioinformatics /Biochemical
/Food/Agriculture/ Environmental or equivalent degree in
relevant discipline or MBBS / B. Pharm./ B. V. Sc./ B.D.S with at least
60% marks (for General / OBC candidates), and 55% marks (for
SC/ST candidates) are also eligible.
viii. For admission to M.Tech. (Plastic Engineering), candidates having degree
of B.Tech./ B.E. in Chemical Engineering/ Chemical Technology / Polymer
Science & Technology / Mechanical Engineering / Production Engineering/
Petrochemical Technology or equivalent of above degrees / course or
M.Sc. Chemistry / Industrial Chemistry / Polymer Science with at least
60% marks (for General / OBC candidates), and 55% marks (for SC/ST
candidates) are also eligible.
ix. For admission to M.Tech. (CAD-CAM), candidates must have B.Tech./ B.E.
in Mechanical Engineering/Automobile Engineering / Chemical
Engineering/ Chemical Technology / Civil Engineering or allied branches
with at least 60% marks (for General / OBC candidates), and 55% marks
(for SC/ST candidates).
x. For admission to M.Tech. (Automation & Robotics), candidates must have
B.Tech. / B.E. in Mechanical Engineering/Electrical Engineering/
Electronics & Communication Engineering / Computer Science &
Engineering or allied branches with at least 60% marks (for General /
OBC candidates), and 55% marks (for SC/ST candidates).

3.2 The equivalency of any degree for admission to any programme will be decided
by the University. The eligibility criteria given above are minimum and mere
possessing the same does not qualify the eligibility for admissions. University
may prescribe any other requirements over and above these conditions.

4. SELECTION PROCEDURE

4.1 The candidate has to fill an application form on-line with all the
relevant details and send print copy of the same along with requisite fee
and certified copy of documents related to qualifications on or before the
last date prescribed by the University. The on-line application is available
on website www.uptu.ac.in. The candidates should fill in and sign the
check list and submit along with the form.
4.2 The sort-listed eligible candidates shall be called for counselling. The
schedule of counselling will be available on the University website
www.uptu.ac.in.
4.3 The number of seats, programmes & institutions may change under very
special circumstances. The same will be posted on the website of the
university.
4.4 Students having domicile of Uttar Pradesh shall be given first
preference and subsequently the candidate having domicile
outside U.P. will be considered only if seats are vacant/ unfilled.
4.5 Candidates with qualifications stated in Section 3 and with valid
GATE/GPAT scores will be given first preference in admission.
4.6 Graduates in Engineering / Technology without valid GATE/GPAT scores
will be given second preference in admission.

5. RESERVATIONS: Reservation shall be applicable as per the State Govt.
norms as prescribed by the Technical Education Department.


6. MEDICAL STANDARDS
6.1 Candidates called for counseling will have to submit an undertaking for Medical
fitness on Certificate Number- 8.
6.2 The candidate should have to submit Medical certificate on proforma given as
Certificate Number - 9 at the time of admission in the college allotted.
Physically Handicapped / Disabled:
Type I Minimum 40% permanent Visual impairment
Type II Minimum 40% permanent Locomotors disability
Type III Minimum 40% permanent speech and Hearing
impairment

7. COUNSELING
7.1 Counseling shall be held at G.B. Technical University (formerly U.P. Technical
University, Lucknow), IET Campus, Sitapur Road, Lucknow. The information
about counseling schedule, procedures and list of sort listed
candidates will be available on website: www.uptu.ac.in. only after
8
th
August, 2011. NO separate counseling letter shall be sent. The
candidates are advised to visit website frequently for counseling
details.
7.2 The candidates called for counseling will be required to come with original
certificates of qualifying examination, mark sheet, weightage certificate,
domicile and category/reservation certificates etc. with one attested copy of
each. In case the candidates do not submit the proper category/ reservation
certificate in the prescribed proforma at the time of counseling, the advantage
of reserved category shall not be provided and they will be treated in General
Category. If a candidate has passed qualifying examination from outside of
U.P., he/she has to bring the domicile certificate of his/her parents (Father or
Mother) only at the time of counseling. The candidate must note that
his/her domicile certificate is not acceptable, in place of his parents
certificate and no request shall be entertained for relaxation.
7.3 Verification of original documents shall be carried out at the time of counseling.
The candidates will not be considered for admission if he/she does not submit
the original documents at the time of counseling. However the originals will be
returned to candidate after verification.
7.4 The initial fee of Rs. 5,000/- will be deposited at counselling centre in the form
of Bank draft. This fee is adjustable against total fee payable at Institution if
candidate takes admission at allotted institute. The initial fee of Rs. 5,000/- will
be forfeited if the candidate does not take admission in the allotted institution.
Requests for return of this fee in such case will not be entertained.
7.5 In addition to initial fee the candidate called for counselling has to deposit a
separate bank draft of Rs. 500/- as counselling fee. This counselling fee is non-
refundable.
7.6 All the Bank drafts must be prepared separately and drawn in favour of
Finance Officer, G. B. Technical University, Lucknow payable at
Lucknow.

8 DOCUMENTS REQUIRED AT THE TIME OF COUNSELLING
The candidates are required to bring the following documents, in original along
with one set of photocopies with them at the time of Counseling:
(a) High School Certificate.
(b) Mark sheets of qualifying examination.
(c) Valid GATE Score Card
(d) Category and Subcategory certificate(s), if applicable.
(e) Passport size Photos. (2 Nos.)
(f) Domicile Certificate
(g) Medical Certificate / Undertaking

9 DOMICILE REQUIREMENTS
9.1 Candidates, who have passed the qualifying examination from an institution
located in the State of Uttar Pradesh and who do not claim for any reserved
category are eligible for admission to all the courses at all the institutions
against available General (OPEN) seats (No certificate required).
[Code: UPGE]
9.2 Candidates, who have passed the qualifying examination from an institution
located in State of U.P.; and are domicile of U.P.; and belong to Schedule Caste
(SC) of U.P. / Schedule Tribe (ST) of U.P. / Other Backward Classes of U.P. are
eligible for admission against available reserved seats of their category.
Certificate no. 1 or 2 as applicable is required. List of SC, ST and OBC castes as
per SC/ST Act 1976 and Government Order 4/1/2001-TC/Ka-2/2002 dt.
19/09/2002 is attached in Appendix E.
[Respective Codes: UPSC / UPST / UPBC]
9.3 Candidates, who have passed the qualifying examination from an institution
located outside U.P.; and whose parents are domicile of U.P.; and who have
not claimed for any reserved category, are also eligible for admission to courses
offered at all institutions under General (OPEN) category. Such candidate has
to produce the domicile certificate of his/her parents (Father or Mother only)
at the time of counseling (certificate no. 3).
[Code: UPGD]
9.4 Candidates, who have passed the qualifying examination from an institution
located outside U.P.; and whose parents are domicile of U.P.; and who belong
to Schedule Caste of U.P. / Schedule Tribe of U.P. / Other Backward classes of
U.P. are also eligible for admission against reserved seats of their category.
Such candidate has to produce the domicile certificate of his/her parents
(Father or Mother only) (certificate no. 3) and category certificate (no. 1 or
2 as applicable) at the time of counseling. List of SC, ST and OBC castes as per
SC/ST Act 1976 and Government Order 4/1/2001-TC/Ka-2/2002 dt. 19/09/2002
is attached in Appendix E.
[Respective Codes:
GDSC/GDST/GDBC]
9.5 The domicile requirement to son/daughter of following is relaxed and
admission is permitted to such
(i) Defense personnel settled in U.P. on the date of Entrance Examination after
retirement / being disabled in action or Defense personnel killed in action and
the dependents settled in U.P. on the date of Entrance Examination. Certificate
no. 5 is required.
(ii) Defense personnel who are not domicile of U.P., but are posted in U.P. on the
date of Entrance Examination. Certificate no. 5 is required.
(iii) Employee of All India Services belonging to U. P. cadre. Certificate no. 11 is
required.
[Code: GDDA]

Proforma of various certificates are available in Appendix A

10. OTHER INFORMATIONS

1. Incomplete applications will be rejected.
2. No TA / DA will be admissible to the candidates called for counseling.
3. The decision of the University for the selection of candidates shall be final.

11. INSTRUCTIONS FOR FILLING ON-LINE APPLICATION FORM
Select any of the courses (M. Tech. or M. Pharm.) from the Course Dropdown.
After selecting the course, the related specialization options would appear in the
Specialization section.
Select Specialization as per your choice by clicking on them and you can select
multiple specialization by pressing control button on the keyboard and selecting the
specialization or you can select it one by one also.
After making the selections click the Right Arrow button on the screen to
move them in the selection list pane.
If you want to remove some of the specializations from the selection pane, select by
clicking on it and click the Left Arrow button on the screen to move them
back into the Select Specialization field.
After making the complete selection, click on the Submit button to navigate to the
Form page for filling the application.
Click Reset button to clear all the selected fields on this page, in-case of any
mistake.
On the Form page, fill in the Draft number, Name of the draft issuing bank, Date
of Issue ( DD/MM/YYYY format) and Amount from the dropdown (Rs. 500 or Rs.
1000)
Then fill in all the particulars of the candidate viz. Name, Date of Birth, Fathers
name, Address, Telephone, Mobile, Fax and Email along with the category, Sub-
Category, Gender, Domicile and Nationality (Indian or Others).
Further, fill in the Particulars of Qualifications which is Examinations passed,
Subject/Branch, Name of University/Institution, Year of Passing, Division and
Percentage of Marks. Fill in the till-date aggregate total in case for the candidates
who have appeared for the final examination and are waiting for their final result.
Fill in your GATE score details, if available.
Fill in the field Place, Upload your Photograph by clicking the Browse button and
selecting your scanned Photograph saved on the hard-drive of your system. MAKE
SURE THAT THE PHOTOGRAPH IS IN JPEG FORMAT AND IT SHOULD NOT
BE MORE THAN 100 MB.
Click and check the Checkbox for the declaration from the student that at all the
information furnished is correct then click Submit button to submit the filled form.
Click Reset button to clear all the filled fields on this page, in-case of any mistakes
or if you want to fill the un-submitted Form again.
Click here to download the CHECKLIST which you would be required to
send along with the printout of this form.

AppendixA



CERTIFICATE 1 (sii si)

~-=l-- il--il- (UPSC/UPST/GDSC/GDST)
{4it + - fn + fni faa/si it faa zii sifia)


t nili- l+i i-i t l+ i+c ...........................................................................
zzi i ........................................ l-i=i nizit .............................................
-t=in ................................................. lni ........................................... <zi ........
............. +i -n ................................ il- n t~i ii ~i t il- ~-=l--
il--il- ~i<zi (=ziii-) (+ +:- + ~--n- ii- =+i-- <zi zii=- ..................
................................... =+i ,ii ni- ~-=l-- il--il- t


~ii + t--i-i t--i-i
l<-i + -in
-ii- nit
lni ~li+ii~l-l+- lni
~li+ii
l=i nl-n-i nl--t=in<i
Note: Proforma of certificate shall be changed according to latest Govt. order.







CERTIFICATE 2 (sii sz)

a-a s<zi + -4 fs n + fny ifa sii s +i ss
(UPBC/GDBC)


t nili- l+i i-i t l+ iin-i +nii .................................................................
=z=zi i .....................................................................................l-i=i nin .......
............................................. -t=in ........................................ -n ........................
.... lni ............................................. -- <zi i +i ......................................
lzi il- + l+- t t il- -- <zi ni+ =i ~-=l-- il-i ~-=l-- -il-i
-ii lz ni + ln( ~i-ii ~lil-n. +- +i ~-=-i + + ~--n- ni--i i-- t
t ii nili- l+i i-i t l+ iin-i+nii ..............................................................
................ -+- ~lil-n +- +i ~-=-i . (~li=--i =i ..+-.+i c.+: ic
=ic l<-i+ l<=-. +: ,ii ii =ziili-) = ~i-zil<- -ti t
iin-i+nii ................................................................ -ii ~ii --+i li --
<zi + nin ..................... iin-i+nii ....................................... -n ..................
.......................... lni ................................... n =ini--i t-i t


~ii + t--i-i t--i-i
l<-i + -in
-ii- nit
lni ~li+ii~l-l+- lni
~li+ii
l=i nl-n-i nl--t=in<i
aia ~ii i- < l+ -cc + ~- lz n + ln( il- nii sn oi, zoii +
z-i- +i -i t~i ti-i ~iz+ t +il+ +inin + ~--n- ~i- in ~lii +i
~i-ii +i nii ~-n- -ti t






CERTIFICATE - 3 (izek.k i=&3)*
a-a s<zi n faiut + s / st (UPGD/GDSC/GDST/GDBC)
{au fn + fri+it zii sifia fu fn + iai/fsai faiut r)

4r sifia f+4i iai r f+ t/tat {4it + fsai/iai +i ai) ...................
...................................fsai/iai t/+o{4it +i ai)....................................
............................................. a-a s<zi + ni/zir ..................................
...... arutn .............................................fni ..................................... +
n faiut r aii t/+o {4it +i ai) ......................................................
..........sa fsai/iai s sia4i ifa r+ aa sa s t/+o {4it +i ai) ..
...........................................................+ iai/fsai uii-4a faiu +a r+


l<-i+ t--i-i lni nl-
-ii- i -in
<-in
nt
(lni nl- +i =in)

*fni faa ii fni faa zii fria s fni faa/u fta faa zii
sii si rt i-4 rin i ziioio uoisz/ata zoozz{II)/s f<ai+ is +t, zoo +
rita it f+4i i4ni+

aianii z. ~ii + ni-il-i +i -i ti-i -ilt( +il+ ~ii l-ti- ~t+ii i-ii --
<zi + it l-i- l+=i lin = --ii +i t -- --+ ni-il-i -- <zi + nn-ii:
l-i=i t













CERTIFICATE 4 {sii s 4) (Sub-Category UPFF)

a-a s<zi ni+ ui {ziitf+ =s u f+nin, aai uni uaiat +
ifai i ias ufa+i + fny i+ii) frifa4, i + aui
a-ai uni uaiat + ifa + sii s +i ss

sifia f+4i iai r f+ t/tat {aiai uni uaiat +i ai) ..................................
............. faiut ni ........................................arutn .........................................
. an .................................................. fni ........................................ a-a s<zi
ni+ ui {ziitf+ =s u f+nin, aai uni uaiat + ifai i ias ufa+i +
fny i+ii) frifa4 i + aui a-ai uni uaiat r i t/tat/+o{ifa
4it +i ai) ........................................................................... s/st/si/
fifra sit asif+a frifa4, i + rt siriiai + aui aa t/tat {a-ai
uni uaiat) .............................................................. + ifa r+


l<-i+ t--i-i
-ii- i -in ( -i<-in
nt (lni nl- +i =in)
Note: Proforma of certificate may be changed according to latest Govt. order.
















CERTIFICATE 5 (izek.k i=&5)

a-a s<zi/uai <n (Sub-Category UPAF)
{fa 4faa + if+u +if-n/fni ufa+ +4ii i zii sifia)

t nili- l+i i-i t l+ iin-i {4it + fsai ii iai +i ai) .................
......................l-i=i nizit .................................................. -t=in .......................
....................... lni ..................................-- <zi. + l<-i+ ..............................+i
=i l-- (Superannuated) z n ni n~n ti n-- <zi n -ni- n --i- t
ii-i in=-in=-ii=-i + -ii- ...................................................... l<-i+.............
............. = l<-i+ .......................... -+ +i- it


l<-i+ l- +nil-n ~il+= + t--i-i
-ii- -in
-it

(fni faa zii sifia)

t nili- l+i i-i t l+ i+c(~ii) ........................................................ l-i=i
................................. -- <zi nizit .............................. -t=in ........................
... lni ................................... -i+- =-i <n + =i l-- (Superannuated) z n
ni n i ~n ti n +n-ii i -- <zi + -iii l-i=i ti. + zzi t --
<zi ii-i in=-in =-ii=-i n +i- it


l<-i+ t--i-i
-ii- -in
nit










CERTIFICATE 6 (izek.k i=&6) (Sub-Category UPHC)
dkmfUlfyax esa tek djus gsrq

ziitf+ f+nin + friia + fny sii s
{4 ff+-ui fri+it zii sifia)

+. t nili- l+i i-i t l+ i+c(~ii) ............................................
.........................zzi i (l-i +i -in) .............................................
................-i- lni +iii = ziiil+ = l+nin t
(+n n l-l+=i ~li+ii ti +ii lni)..................................................
................................................................................................................
.. ~ii +i -i+- l+nin-i +i l--- +i +i l+nin-i +i ii n ii i
=+-i t
(+i +i l-zii- nni)
Type - I: Minimum 40% permanent Visual impairment
Type-II: Minimum 40% permanent Locomoter disability
Type-III: Minimum 40% permanent Speech Hearing impairment
.. t ii nili- l+i i-i t l+ -i+- l+nin l-il- ~ii +
:-il-ln lzi-ii i-- +- n ii+ -ti tini


~ii + t--i-i l-l+=ili+ii + t--i-i
-in -in
l<-i+ nt













CERTIFICATE 7 (sii sz)
* FORMAT FOR MEDICAL CERTIFICATE
(To be obtained from a Chief Medical Officer or Medical Officer of a participating U.P. State Funded Engineering
Institute)

This certificate has to be submitted at the time of admission in the college allotted.

( To be filled in by the Candidate )
Name of Candidate: Age: Sex:
Category: Subcategory :
Father's Name:

L.T. M.I.
Height Weight Chest Abdomen
V
I
S
I
O
N
Colour Vision:
Without glass:
With glass:
History Operation Kockh's Colics B.P.

Seizures Asthma Piles Diabetes
E
X
A
M
I
N
A
T
I
O
N
Pulse Tonsil DNS Hernia

Pallor L.Nodes CSOM Hydrocele
Cardiovascular CNS

Respiratory GIT

Genitourinary Others
Is the candidate physically handicapped/Disabled: (Please tick) Yes / No
If yes, type of handicap/disability:
Type-I: Minimum 40% permanent Visual impairment
(Please trick the type of handicap/disability) Type-II: Minimum 40% permanent Locomotors disability
Type-III: Minimum 40% permanent speech and
Hearing impairment
Any other finding:
Certified that the candidate is physically fit/unfit/temporally disqualified to pursue engineering studies




Signature of Candidate Signature of the issuing Medical Officer ( with
Official stamp)


CERTIFICATE 8 (sii ss)
UNDERTAKING BY CANDIDATE FOR MEDICAL FITNESS

I certify that I have no such physical handicap/disability which would hinder the pursuit of
studies in the courses in which I am seeking admission. If at stage it is found that I have a
physical handicap/ disability which would hinder the pursuit of studies in the courses in
which I am seeking admission then my admission will be liable to be cancelled. I will produce
medical fitness certificate from a C.M.O./C.M.S. at the time of my joining the institution
allotted by GBTU-counseling.


Date: Counter Signed by Father / Guardian Signature of the Candidate