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Birla Institute of Technology & Sciences, Pilani

BITSAT-2017
ONLINE APPLICATION FORM

Application Number: 511277

Personal Details :

Full Name : PARTH B. PATEL

Gender : MALE
Date of Birth : 20-JUL-1999

Father's Name : BABUBHAI M PATEL

Mother's Name : SHITAL M PATEL

Nationality : INDIAN
Email-Id : LycanParth21@icloud.com
Address : B/4 YAMUNAKUNJ SOC., NR. GEETA PARK

VADODARA

City : VADODARA - 390011

State : GUJARAT

Land line no. :

Mobile No. : 9558776197

Academic Details :
Name of the Institution
Examination
Name of Examination Board
Year of Passing
Subject selected for Part IV of
BITSAT
Test Center Preferences
: BHARATIYA VIDYA BHAVAN'S VALLABHRAM MEHTA PUBLIC SCHOOL
: 12th CLASS (or) ITS EQUIVALENT
: CENTRAL BOARD OF SECONDARY EDUCATION - ALL INDIA SENIOR SCHOOL CERTIFICATE
EXAMINATION [CBAT]
: 2017
: MATHEMATICS
: Preference1: VADODARA
Preference2: AHMEDABAD
Preference3: SURAT

Payment Details:-Application fee paid through online mode with the below particulars.
Transaction Number Transaction Date Transaction Amount (INR)
287534218 09-01-2017 2781.63

Declaration: I hereby declare that all particulars given in this application form are true to the best of my knowledge and belief. I have
read and understood all the instructions for appearing in BITSAT-2017. I shall abide by the terms and conditions of BITSAT-2017.

* Do not post this application to BITS, Pilani.