SRM UNIVERSITY

Student Counseling - Record

(to be filled and produced at the Registration Desk)
Batch: 2015

Date & Session : 19.05.2015 Afternoon To Report 1.30 p.m

1. Rank in SRMJEEE 2015

16546

2. Qualifying exam details : HSC or Equivalent Board

Sub

Maths

Phy

Che

Bio

.......................................................................
Botany

Zoology

Aggregate %
PCM/PCB

Marks
obtained
Max. Marks

3. Register Number in SRMJEEE 2015

4. Name of the Candidate

ASHISH JHA
............................................................................

5. Gender

6. DOB

7. Mobile Phone No :
(Compulsory)

8. Email (Compulsory)

ashishatomjha@gmail.com

9. Course

B.Tech

10.Branch Chosen

11.Campus Chosen

12.SRM University,Haryana

1530210091

19-03-1998

(DD-MM-YYYY)

9971903652

DD details : Name of the Bank : ...............................................................................................................

Amount : .................. DD Number : .................. Date : .....................
Declaration
* This is certify that I have not yet received the results / marks sheets of the qualifyimg examinations. I am
attending the counseling at my own risk. I am aware that the admission offered is provisional and I will
forgo the seat allotted if I fail to satisfy the eligibility requirements

* I agree to the statement given above by my

Signature of the Student

* Strike out if not applicable

Place & Date: SRM Nagar.................................
Admitted / Not Admitted
Counselor (To retain this record)

Signature of the Parent/Guardian

Verified
Registration Officer