KIIT UNIVERSITY  

  
BHUBANESWAR, ORISSA, INDIA   
KIITEE - 2011   
APPLICATION FORM   

 Registration No :
  Candidate's Name PRATIMA SAHU
1
.
3
0
7 Paste recent Passport size
5 Photograph
0 (The photograph must indicate
7 clearly the name of the
 2. Father's Name G S SAHU candidate)
 3. Mother's Name BED SAHU (4 cm x 5 cm size)
 4. Date of Birth 09/07/1990 (Don’t staple)
 5. Sex FEMALE
 6. Nationality INDIAN
 7. Category Reservation GENERAL
   Odisha State Candidate No
 8. Course Applied BBA/ BCA (3 YEARS)
9. Centre Option 1. BILASPUR 2. NAGPUR
 10. Qualification Details
Qualification 10 + 2
Qualifying Exam Status PASSED - 2008
% Marks in Aggregate 69.40

Class X Roll No 1158102

Class X Board Name CBSE Candidate's Signature
Class X Pass Year 2006
 11. Communicational Address
Line 1   QR NO. 277/D
Paste recent Passport size
 Line 2   RISALI SECTOR
Photograph
Line 3   BHILAI
(The photograph must indicate
City BHILAI
clearly the name of the
State  CHHATTISGARH
candidate)
Pincode 490006
(4 cm x 5 cm size)
Phone No.
(Don’t staple)
Mobile No.  9301236303
 12. Email Id atul4bca@yahoo.co.in
Declaration:
I hereby undertake that the information given through this Application form are true and correct to the best of my Knowledge.

 
Check List: Yes No  
1. Xerox copies of Class X Marksheet/Certificate enclosed
2. Two passport size photographs (must indicate clearly the name of the candidate) pasted in the
registration form in the boxes provided
3. Signed by both Candidate and Guardian
No Application / Examination Fees for KIITEE - 2011
 
Close
  

Registration No :    307507

 
 
 
From
 
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To
Director Admissions
Admission Cell (Koel Campus),
KIIT University,
P.O.-KIIT,
Bhubaneswar-751024
Orissa, India.
Ph.- 0674-2742103, 2741389, 2741998
Fax:- 0674-2741465