GOVERNMENT POLYTECHNIC COLLEGE, JODHPUR

Centralised Admission in First Year for Diploma Engineering Course(2017-2018)

Online Application Form
Unique Id :DTE-257186-2017
App. No. : 17105657
1. Name of Candidate: AKHIL AGRAWAL
2. Father's Name: RAMPRAKASH AGRAWAL
3. Mother's Name: NISHA AGRAWAL
4. Marital Status: SINGLE
5. Gender: MALE
6. Category-A: GENERAL
7. Category-E: NO
8. Date of Birth: 22 AUG, 2000
9. Preferential Category: 2 - NON RESIDENT OF RAJASTHAN
10. Nearest Nodal Centre: SH. GOKUL VERMA GOVT. POLYTECHNIC
COLLEGE, BHARATPUR
11. Complete Address: ISLAM GANJ, FATEHPUR SIKRI, AGRA,
UTTAR PRADESH, AGRA-283110
12. Email Id: akhilagrawalfts22@gmail.com
13. Phone No.:
14. Mobile No.: +918273585865 Transaction ID. 2CC6688CC6FE50
Amount (Rs) 300.00
Payment Date 2017-07-04 18:59:17
15. Qualifying Examination Details(Secondary):
Maths Science Aggregate
Exam- Details Board State of Study Year Roll No. Max Marks Marks Max Marks Marks Max Marks Marks %
Obtained Obtained Obtained

SECONDARY (X) UP BOARD UTTAR PRADESH 2015 0066912 100 73 100 68 600 441 73.5000

16. Religion HINDU 17. Area of Residence URBAN

18. Parent's Income from all Sources LESS THAN 6 LACS

UNDERTAKING:

I hereby solemly and sincerely affirm that all the information furnished by me in the application form are true. I have not concealed any information. If any information
furnished to be is found to be fraudulent or untrue at any stage I am liable to criminal prosecution and I also agree to forgo my seat. Further the selection and admission
to the course is liable to be cancelled. I agree to abide by the rules and regulations governing the Admission as contained in the Information Booklet which I have duly
gone through

Signature of Candidate
 GOVERNMENT POLYTECHNIC COLLEGE, JODHPUR
Centralised Admission in First Year for Diploma Engineering Course(2017-2018)
Online Option Form

A. General Details of Candidate

1. App No. 17105657 2. Transaction ID 2CC6688CC6FE50
3.Name AKHIL AGRAWAL 4. Father's Name RAMPRAKASH AGRAWAL
5. Mother's Name NISHA AGRAWAL 6. Date of Birth 22 AUG, 2000
7. Category GENERAL 8. Sex MALE

List of Institutes and branches as per my choice preferences

S.No. College Branch
1. Sh. Gokul Verma Govt. Polytechnic College, NH-11 Sewar Bye Pass, Bharatpur(005) CIVIL (GAS)
2. Sh. Gokul Verma Govt. Polytechnic College, NH-11 Sewar Bye Pass, Bharatpur(005) MECHANICAL (GAS)
3. Sh. Gokul Verma Govt. Polytechnic College, NH-11 Sewar Bye Pass, Bharatpur(005) ELECTRICAL (GAS)
4. Govt. Ram Chandra Khaitan Polytechnic College,Jhalana Dhoongri,Jaipur(008) CIVIL (GAS)
5. Govt. Ram Chandra Khaitan Polytechnic College,Jhalana Dhoongri,Jaipur(008) MECHANICAL (GAS)
6. Govt. Polytechnic College,Near Itarana Flyover,Alwar(002) CIVIL (GAS)
7. Govt. Polytechnic College,Near Itarana Flyover,Alwar(002) ELECTRICAL (GAS)
8. Rajesh Pilot Govt. Polytechnic College, Jirota Khurd, Jaipur Road, Dausa(048) MECHANICAL (GAS)

Signature of Candidate
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