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18, Knowledge Park-II, Greater Noida-201306 (UP)
Ph No : 0120-6002159/ 62/ 63/ 65, 8860427532 / 8860427537 Fax:0120-2320058
Website : www.iilm.ac.in/gnoida, Email: cet.admissions@iilm.ac.in

Registration Form
Course Applied for: B.Tech / M.Tech (BT/ME/EEE) / MBA/ MAM
Branch Preference: (Applicable for B.Tech only)

Biotechnology
Computer Science & Engineering
Electronic & Communication Engineering
Electrical & Electronic Engineering
Mechanical Engineering
Automobile Engineering
1. Name of Candidate: ________________________________________________________________________
2. Date of Birth: ____________________________________________
3. Guardians Name & Relationship: _____________________________________________________________
4. Address for Correspondence:_________________________________________________________________
_________________________________________________________________________________________
5. Mobile No: _____________________________

Alt Mobile No: _________________________________

6. Email Id: _______________________________


7. Details of Qualifying Examination:
S. NO.

Examination Passed

1.

10th

2.

12th

3.

Graduation

Roll No.

Board/University

Year of Passing

%age of Marks

Major Subjects

8. Aggregate Marks in PCM /PCB(for B Tech only):


9. Details of Competitive Exam appeared in:
Examination

Year

10. Hostel required:

YES / NO

11. Transport required:

YES / NO

(Signature of Candidate)

Roll No

Rank

Remarks

(Signature of Parent / Guardian)

SUBMISSION / ACCEPTANCE OF REGISTRATION FORM DOES NOT GUARANTEE ADMISSION

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