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GOVERNMENTPOLYTECHNICCOLLEGE,JODHPUR
CentralisedAdmissioninFirstYearforDiplomaEngineeringCourses2015
OnlineApplicationForm

App.No:811373

TokenNo:1506069110099009

1. NameofCandidate:
2. Father'sName:
3. Mother'sName:
4. MaritalStatus:
5. Gender:
6. CategoryA:
7. CategoryB:
8. CategoryC
9. CategoryD
10. TribalArea
11. NameofVillageofTribalArea
12. DateofBirth:
13. PreferentialCategory:

JUNED
MAHMOODKHAN
HARUNI
UNMARRIED
MALE
OBC
NONE

03Jul1998
1APassedSec.Exam
FromRBSE/CBSEas
Reg.studentfromany
schoolsituatedinRaj.
02GOVT.POLYTECHNIC
COLLEGE,ALWAR
GODHAN,TEHTIJARA,
BHIWADI
ALWAR,RAJASTHAN301019
munsariph786@gmail.com

14. NearestNodalCentre:
15.CompleteAddress:

16.PhoneNo:
17.MobileNo:

Secondary(X)

RBSE

1506069110099009

TokenAmt.

300

TokenDt.

01/07/2015

9887157275

18.QualifyingExaminationDetails:
Exam.Details Board

TokenNo.

StateOf
Study

Year

RollNo

RAJASTHAN

2015

0093202

Max.
Marks

Maths
Marks
Obtained

100

19.Religion:

MUSLIM

21.Parent'sIncomefromallSources

lessthan6Lacs

47

Science
Max.
Marks
Marks Obtained
100
53

20.AreaofResidence

Aggregate
Max.
%
MarksObtained
Marks
600
376
62.6

RURAL

I hereby solemnly and sincerely affirm that all the information furnished by me in this application form are true and correct. I have not concealed any
information.However,ifanyinformationfurnishedhereinisfoundtobefraudulent,incorrectoruntrueatanystage.IamliabletocriminalprosecutionandI
also agree to forgo my seat. Further that the selection and admission to the course is liable to be cancelled. I agree to abide by the Rules and Regulations
governingtheAdmissionascontainedintheInformationBooklet,whichIhavedulygonethrough.

SignatureofCandidate
DOCUMENTSTOBEATTACHEDWITHAPPLICATIONFORM(TickforDocumentsAttached)
1 SelfattestedcopyofmarksheetofSecondarySchoolExamination.

2 Selfattestedcopyofrelevantcertificatesnecessaryforclaimingthereservation.

3 Selfattestedcopyofrelevantdomicilecertificatewhicheverisapplicable.

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CentralisedAdmissionforDiplomaEngineeringCourses2015C81137308Jul2015

GOVERNMENTPOLYTECHNICCOLLEGE,
JODHPUR
CentralisedAdmissionforDiplomaEngineeringCourses2015

A.GeneralDetailsofCandidate

1Exxz1Dz

1. FormNo

811373

2.Name

JUNED

3.Father'sName
5.DateofBirth

MAHMOODKHAN
03Jul1998

4.Mother'sName
6.Category

HARUNI
OBC

7.Sex

MALE

8.TokenNo

1506069110099009

B.Listofinstitutesandbranchesaspermychoicepreferences
S.No.
College
1. Govt.PolytechnicCollege,Alwar

Branch
Mechanical

3.

Govt.PolytechnicCollege,Alwar

5.

Govt.PolytechnicCollege,Karauli(CampGovt.
Mechanical
PolytechnicCollege,Alwar)
Govt.RamChandraKhaitanPolytechnicCollege,Jaipur Mechanical
Sh.GokulVermaGovt.PolytechnicCollege,Bharatpur Civil

7.
9.

Electrical

11. Govt.RamChandraKhaitanPolytechnicCollege,Jaipur Mechanical

Production
13. Govt.PolytechnicCollege,Ajmer
Mechanical
15. Govt.PolytechnicCollege,Ajmer(IIndShift)
Mechanical
(Automobile)
17. Govt.PolytechnicCollege,Ajmer
Electrical
19. Govt.RamChandraKhaitanPolytechnicCollege,Jaipur Civil
21. SiddhiVinayakPolytechnic,E1,B1,M.I.A.Ext.,
InstitutionalArea,Alwar
23. LaxmiDeviInstituteofEngineeringANDTechnology,
AlwarTijaraDelhiHighway,Chikani,Alwar
25. Dr.RadhaKrishanPolytechnicInstitute,VPOBasni,
Teh.Mundawar,Alwar
27. BansurPolytechnicCollege,Bansur,Dist.Alwar

Mechanical
Mechanical
Mechanical
Mechanical

S.No.
College
2. Govt.PolytechnicCollege,Alwar
4.

Govt.PolytechnicCollege,Neemrana

Branch
Civil

6.

Mechanical
(Automobile)
Civil

14. Govt.PolytechnicCollege,Ajmer
16. Govt.PolytechnicCollege,Ajmer(IIndShift)

Civil
Civil

Govt.PolytechnicCollege,Karauli(CampGovt.
PolytechnicCollege,Alwar)
8. Sh.GokulVermaGovt.PolytechnicCollege,BharatpurMechanical
10. Sh.GokulVermaGovt.PolytechnicCollege,Bharatpur Mechanical
(IIndShift)
12. Govt.PolytechnicCollege,Sikar
Mechanical

18. Sh.GokulVermaGovt.PolytechnicCollege,BharatpurElectrical
20. Govt.PolytechnicCollege,Karauli(CampGovt.
Electrical
PolytechnicCollege,Alwar)
22. SiddhiVinayakPolytechnic,E1,B1,M.I.A.Ext.,
Civil
InstitutionalArea,Alwar
24. LaxmidharPolytechnicCollege,1N3,MIA,RIICO, Mechanical
Alwar
26. DholaplashPolytechnicCollege,Vil.Dholaplash,Near Mechanical
SonpurBusStand,SonpurHighway,Alwar
28. BhiwadiCollegeofPolytechnic,HI496(G),PhaseI, Mechanical
RIICOIndustrialArea,Bhiwadi,Alwar

1Exxz1Dz

SignatureOf
Candidate

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