APPLlCATlON NUMBER

READ DETAlLED lN5TRUCTlON5 GlVEN 5EPARATELY

BEFORE FlLLlNG THE APPLlCATlON FORM
Paste your recent
passport slze co|our
pbotograpb not o|der
tban 3 montbs. Do not
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PHOTOGRAPH
5lGNATURE OF APPLlCANT
APPLlCATlON FORM
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NAML OP THL APPL|CANT (AS |T APPLAPS |N CLASS X OP LQU|vALLNT MAPKS CAPD)
DATL OP 8|PTH SLX (T|CK)
MALL DATL MONTH YLAP PLMALL
COUPSL CHO|CL
CHO|CL 1 CHO|CL 2 CHO|CL 3
NAML OP THL PAPLNT / GUAPD|AN
ADDPLSS POP COPPLSPONDLNCL
DOOP / HOUSL No.
STPLLT NAML
PLL|G|ON
CATLGOPY (T|CK)
8C SC ST Otbers PH
LMA|L |D
P|N CODL STATL D|STP|CT
LOCAL|TY / MANDAL
TLLLPHONL NUM8LP MO8|LL NUM8LP STD CODL
TOWN / C|TY
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APPLlCATlON FEE DETAlL5 : CASH : OR DD :
PAYMENT MODE NUMBER DATE AMOUNT l55UlNG BANK NAME
DD DETAlL5
BRANCH
CA5H RECElVED BY : Mr./Ms. .............................................. Slgnature ...................................... P|ace .........................................................
5lGNATURE OF APPLlCANT
ACADEMlC DETAlL5
1. X C|ass
State :
Year o| Pass : 8oard :
Year o| Pass :
Unlverslty :
Co||ege :
YEAR / 5EME5TER MAXlMUM MARK5 MARK5 OBTAlNED
TOTAL
MONTH & YEAR
P|ace : ............................
Date : ............................
DECLARATlON: | bereby dec|are tbat a|| tbe partlcu|ars stated ln tbls app|lcatlon are true to tbe best o| my know|edge and be|le|. | bave read and
understood a|| provlslons o| tbe admlsslon procedure and agree to ablde by tbem. |n tbe event o| submlsslon o| |raudu|ent, lncorrect or untrue
ln|ormatlon or suppresslon or dlstortlon o| any |act |lke educatlona| qua|l|lcatlon, marks etc., | understand tbat my admlsslon / degree ls |lab|e |or
cance||atlon. Purtber | understand tbat my admlsslon ls pure|y provlslona| subject totbe |u||l|ment o| tbe e|lglbl|lty crlterla.
5lGNATURE OF PARENT/ GUARDlAN
5ignature of officia| with sea|
vlgnan Unlverslty / Scboo| / Co||ege / Lngg. Co||ege
2. 10+2 or equiva|ent Group : MPC : 8lPC :
Marks : TOTAL MAPKS MAPKS O8TA|NLD % OP MAPKS
State :
Year o| Pass : 8oard :
Marks : TOTAL MAPKS MAPKS O8TA|NLD % OP MAPKS
3. Graduation :
Marks Detal|s : %OF MARK5
| YLAP / | SLM
| YLAP / || SLM
|| YLAP / ||| SLM
|| YLAP / |v SLM
||| YLAP / v SLM
||| YLAP / v| SLM
|v YLAP / v|| SLM
|v YLAP / v||| SLM
GATE / PGECET / OTHER TE5T 5CORE
TE5T NAME TE5T DATE FORM NO 5CORE
ACKNOWLEDGMENT
Name o| tbe App|lcant : ..................................................................................... S/o / D/o ...........................................................................................
Pecelved app|lcatlon |or Admlsslon to M.Tech (Macblne Deslgn / CAD-CAM / Communlcatlon & Slgna| Processlon / Lmbedded Systems / Power L|ectronlcs & Drlves / CSL
/vLS|).
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WORK EXPERlENCE
DE5lGNATlON WORKlNG lN5TlTUTlON & PLACE
FROM TO
DURATlON OF WORKlNG