Date of receipt _______________

Regn. No. _______________

(Not to be filled in by the candidate)

NATIONAL INSTITUTE OF TECHNOLOGY, KURUKSHETRA

ABSTRACT FORM (2011-2012)

(To be filled in for all the courses)
Applied for Admission to
M. Tech. Degree Course

Civil

Mechanical

Electrical

Computer

Electronics

Physics

Tick () the box whichever is applicable.

1.

Name in full (in block letters) * _________________________________________

2.

Fathers name (in block letters) * ________________________________________

3.

Date of birth (in words) ** ____________________________________________

One thousand nine hundred and _________________________________________
(in figures) _________________________________________________________

4.

Address for Correspondence ___________________________________________

________________________________________________
________________________________________________
Telephone:____________ Fax:_____________E-mail:______________________
Mobile No: ____________________________

-----------------------------------------------------------------------------------------------------------* As in qualifying examination

** As in Matriculation Certificate

* Merit No.

* Institute Roll No.. ..

NATIONAL INSTITUTE OF TECHNOLOGY, KURUKSHETRA

Application Form for Admission to Four-Semester M.Tech. Degree Courses
for Academic session 2011-2012
th

Last Date for Receipt of Application 13 June, 2011 (Monday) by 5.00 pm

DEPARTMENT**
SPECIALISATION (IN ORDER OF PREFERENCE)
(I) -----------------------------------------------------PASSPORT
(II) -----------------------------------------------------SIZE
(III) -----------------------------------------------------PHOTOGRAPH
(IV) -----------------------------------------------------(V) -----------------------------------------------------CATEGORY: SPONSORED /NON-SPONSORED/SC/ST
1.
Name in Full .
(in block letters)
2.
Fathers Name ..
(in block letters)
3.
Mothers Name .
(in block letters)
4.
Date of Birth (as in Matriculation/higher Secondary Exam.)
.. One thousand nine hundred and ..
. (In figures) ....
5.
Address (in block letters) .. .
..
Mobile/Phone No. (if any)., E-mail.
6.
Nationality . Religion .
7.
Do you belong to Scheduled Caste/tribe/OBC?
Yes / No
(if yes, attach certificate in support thereof)
8.
Do you belong to Rural /Urban area ....Rural/Urban
9.
Annual Income from all sources
Rs. ..
10.
Details of Examination Passed
Exam.
Passed
(with discipline)
BE/B.Sc.
(Engg.)/
B.Tech.(
)
M.Sc. (

Year

Roll No.

Div.

Marks
Obtained

%age Name of Institute &

Marks
University

*Not to be filled by the candidate

**Separate application should be submitted for different courses

11.

Have you qualified the GATE? Yes / No

If yes, please indicate
(Year)
(Roll No.)
(score)

12. Have you taken admission in any institute/discipline on the basis of

GATE? Yes / No If yes, give particulars.
Institute .
Year Discipline
Roll No. ..Amount of Scholarship drawn .
13. Have you ever been disqualified or debarred from appearing in any examination conducted by a
University/ Board? Yes / No
If yes, give particulars:..
DECLARATION BY THE CANDIDATE
It is declared that all the entries made in this form are correct. I further declare that I fulfill the
minimum eligibility conditions laid down for admission. In case of detection of any false entry,
especially in respect of degree examination/experience/sponsoring certificate, my admission may be
treated as cancelled any time during the course of my study and I will have no claim what-so-ever.

Date

Signature of the Applicant

DECLARATION BY THE FATHER/GUARDIAN

I certify that my son/daughter/ward .. submits the
application with my knowledge and consent and that I hold myself responsible for his good conduct
and for his maintenance and payment of fees during the period he/she is on the Institute Rolls.

Signature of Father/Guardian

Date
LIST OF ENCLOSURES
a)
b)
c)
d)
e)
f)
g)

B.E. /B.Tech/ M.Sc. Examination Detailed Marks

Yes/No
GATE Score Card
Yes/No
Character Certificate from Head of Institution last attended
Yes/No
Matriculation/Higher Secondary Part-I Exam
Yes/No
SC/ST/OBC Certificate
Yes/No
Sponsorship Certificate /No Objection Certificate
Yes/No
Photocopies of (I) PF Account No. (ii) ESI from Sponsoring
Yes/No
Firm (iii) Last Pay Certificate, (If applicable) 1956
Act Indian Companies Act.
h) Bank Draft of Rs. 1000/- in favour of Director, NIT Kurukshetra payable at SBI Kurukshetra.

SPONSORSHIP CERTIFICATE
Certified that Mr./Ms. S/o/D/o
Shri. Working as in the department
of from (date) is a
permanent employee of this department/ organization. His/Her name is hereby sponsored for 4Semester M. Tech. Degree Course. He/She fulfills the minimum eligibility conditions laid down for
admission to this course. He/She will be relieved for the said course on the production of Admission
Letter.
It is further certified that no enquiry is pending against him/her and he/she will be relieved to
join the course, if selected. He/She will be absorbed in our Organisation/ Deptt. after the completion of
the course.
Date
No.

Signature of the sponsoring

Authority with Stamp

NO OBJECTION CERTIFICATE
For Non- sponsored but in service candidates
Certified that Mr/Ms. ______________________ S/o/D/o Shri __________________ working
as __________________ in the department of ______________________________ from (date)
_______________________ is a permanent employee of this Department/ Organization. We have no
objection to his/her joining the M.Tech. Degree Course.
Date
No.

Signature of the sponsoring

Authority with Stamp

ADDITIONAL CERTIFICATE IN CASE OF CANDIDATE

SPONSORED BY ORGANISATIONS OTHER THAN THE
STATE GOVERNMENT OF HARYANA

Name of the Candidate ...

Status: Permanent / Temporary ..
Name of Sponsoring Organisation .
*Regn. No. under the Indian Companies act, 1956 ....
Annual Turn-over (Rs.)....
Total Manpower Employed (on regular basis) ....
No. of Diploma Holders Employed (on regular basis) ....
No. of Engineering Graduates Employed (on regular basis)
**Will the applicant be retaining lien? ....
P.F.A/c No. of the Applicant ...
E.S.I. Regn. No. of the Applicant
Certified that Mr/Ms._________________________________ will be absorbed in our
organization/Deptt. after the completion of the course.
Date .
Signature of the Sponsoring
No. .
Authority with stamp
--------------------------------------------------------------------------------------------------------------------------*
Enclose an attested copy of this certificate showing Registration number under Indian
Companies act, 1956.
**
If NOT, the candidate will not be considered for admission.