BIHAR PRIVATE TECHNICAL & PROFESSIONAL INSTITUTIONS ASSOCIATION

Exam. Controller Off.: G 102, Ranjeet Complex, Talpetra Lane, Budha Marg, Patna -800001
Web site: - www.bihartechassociation.org, E-mail:- biharpvtassociation@gmail.com
Phone No.: 0612-2237222, Mobile No. 8544419953

COUNSELLING PERFORMA FOR ADMISSION IN DIPLOMA IN

ENGINEERING COURSES SESSION: - 2015-16

1. Name of the candidate (Block Letters):- ...

2. Sex: Male Female
3. Roll No. of the Bihar Private Combined Competitive Examination: - ...
4. Fathers Name: - .
5. Address for Correspondence: - .
...
Phone No. Mobile No. E-mail Id.
6. Date of Birth . (In words) ..
7. Examination passed:-
Secondary Examination: Year of Passing ...
Division ...
% of Marks ...
8. Declaration by Candidate:-
(i) I declare that information furnished above are correct.
(ii) I promise to abide by all the rules and regulations of the institute during my studies in the college
and shall be liable to disciplinary action in case of committing misconduct.

(Signature of the candidate in full)

9. Institute and Branch allotted as per candidates choice:-

(i) Name of Institute ..
(ii) Name of Branch ..

(Signature of the candidate)

10. Documents produced for verification in original:-
(i) (ii)
(iii) (iv)
(v)

11. Observation of the Counselling officer (if any):-

Signature of Counselling Officer : ..

Name : ..