KANPUR INSTITUTE OF TECHNOLOGY

KANPUR INSTITUTE OF TECHNOLOGY

A-1, UPSIDC INDUSTRIAL AREA,
ROOMA, KANPUR – 208001
UTTAR PRADESH

COLLEGE REGISTRATION FORM - Institute Copy

(Provisional, subject to the compliance of Rules/Regulation of UPTU, Lucknow)
B.TECH./MCA/MBA/M.TECH (PRE-ENROLLED STUDENTS): 2018-19

IMPORTANT : Candidates should fill the entries very carefully.

UNIVERSITY ROLL NO. : 1516521010

Name of Course & Branch : B.Tech.(EN)

Year : 4
Semester : 8
Status of Student : Regular
Name of Student: INSAF ALI
(As per High school Certificate in English)

Name of Student:
(In Hindi)

Father's Name : RAHMAT ALI

(As per High school Certificate)

Occupation : Agriculture Annual Income : 28000.00

Mother's Name : ASHIYA KHATOON
(As per High school Certificate)

Date of Birth : 14-JUL-1998

Category (GEN/OBC/SC/ST) : OBC
Permanent Address :
Pincode : 272208
Local Address : VILL SARNGI
POST USKA BAZAR
SIDDHARTHA NAGAR
UTTAR PRADESH
INDIA
Pincode : 272208
Student Mobile No. : 8317027440
Student Email Id : 1516521010@kit.ac.in
Parents Mobile No. : 8808214804
Parents Email Id:

Qualification Details
S.No. Qualification Passing Year Board/Univers Institute/Colle Highest Percentage
ity ge Qualification
1 10th 2013 U.P. BOARD N 76.50
OF HIGH
SCHOOL &
INTERMEDI
ATE
EDUCATION
2 12th 2015 U.P. BOARD N 67.20
OF HIGH
SCHOOL &
INTERMEDI
ATE
EDUCATION
3 BTech I 2015 DR. A.P.J. KANPUR N 62.80
Semester ABDUL INSTITUTE
KALAM OF
TECHNICAL TECHNOLO
UNIVERSIT GY,
Y, KANPUR
LUCKNOW
4 BTech II 2016 DR. A.P.J. KANPUR N 75.30
SEMESTER ABDUL INSTITUTE
KALAM OF
TECHNICAL TECHNOLO
UNIVERSIT GY,
Y, KANPUR
LUCKNOW
5 BTech IV 2017 DR. A.P.J. KANPUR N 76.70
SEMESTER ABDUL INSTITUD
KALAM OF
TECHNICAL TECHONOL
UNIVERSIT OGY
Y, ROOMA
LUCKNOW
6 BTech VI 2018 DR. A.P.J. KANPUR N 76.20
SEMESTER ABDUL INSTITUD
KALAM OF
TECHNICAL TECHONOL
UNIVERSIT OGY
Y, ROOMA
LUCKNOW
7 BTech VII 2017 DR. A.P.J. KANPUR N 71.00
SEMESTER ABDUL INSTITUD
KALAM OF
TECHNICAL TECHONOL
UNIVERSIT OGY
Y, ROOMA
LUCKNOW
8 BTech VIII 2019 DR. A.P.J. KANPUR N 76.00
Semester ABDUL INSTITUD
KALAM OF
TECHNICAL TECHONOL
UNIVERSIT OGY
Y, ROOMA
LUCKNOW
 Declaration
I INSAF ALI hereby declare that all statements in this application are true, complete and correct to the best
of my knowledge and belief. I shall be liable to a punishment in the event of providing any wrong
information. Further, I shall obey all the rules and regulations of KANPUR INSTITUTE OF
TECHNOLOGY.

Date : 26-Jan-2019
Place :

(Signature of Student)

(Authorized Signatory)
KANPUR INSTITUTE OF
TECHNOLOGY

Enclosure :
(1)Affidavit of Student for Anti-Ragging.
(2)Affidavit of Parents for Anti-Ragging.
 KANPUR INSTITUTE OF TECHNOLOGY
KANPUR INSTITUTE OF TECHNOLOGY
A-1, UPSIDC INDUSTRIAL AREA,
ROOMA, KANPUR – 208001
UTTAR PRADESH

COLLEGE REGISTRATION FORM - Student Copy

(Provisional, subject to the compliance of Rules/Regulation of UPTU, Lucknow)
B.TECH./MCA/MBA/M.TECH (PRE-ENROLLED STUDENTS): 2018-19

IMPORTANT : Candidates should fill the entries very carefully.

UNIVERSITY ROLL NO. : 1516521010

Name of Course & Branch : B.Tech.(EN)

Year : 4
Semester : 8
Status of Student : Regular
Name of Student: INSAF ALI
(As per High school Certificate in English)

Name of Student:
(In Hindi)

Father's Name : RAHMAT ALI

(As per High school Certificate)

Occupation : Agriculture Annual Income : 28000.00

Mother's Name : ASHIYA KHATOON
(As per High school Certificate)

Date of Birth : 14-JUL-1998

Category (GEN/OBC/SC/ST) : OBC
Permanent Address :
Pincode : 272208
Local Address : VILL SARNGI
POST USKA BAZAR
SIDDHARTHA NAGAR
UTTAR PRADESH
INDIA
Pincode : 272208
Student Mobile No. : 8317027440
Student Email Id : 1516521010@kit.ac.in
Parents Mobile No. : 8808214804
Parents Email Id:

Qualification Details
S.No. Qualification Passing Year Board/Univers Institute/Colle Highest Percentage
ity ge Qualification
1 10th 2013 U.P. BOARD N 76.50
OF HIGH
SCHOOL &
INTERMEDI
ATE
EDUCATION
2 12th 2015 U.P. BOARD N 67.20
OF HIGH
SCHOOL &
INTERMEDI
ATE
EDUCATION
3 BTech I 2015 DR. A.P.J. KANPUR N 62.80
Semester ABDUL INSTITUTE
KALAM OF
TECHNICAL TECHNOLO
UNIVERSIT GY,
Y, KANPUR
LUCKNOW
4 BTech II 2016 DR. A.P.J. KANPUR N 75.30
SEMESTER ABDUL INSTITUTE
KALAM OF
TECHNICAL TECHNOLO
UNIVERSIT GY,
Y, KANPUR
LUCKNOW
5 BTech IV 2017 DR. A.P.J. KANPUR N 76.70
SEMESTER ABDUL INSTITUD
KALAM OF
TECHNICAL TECHONOL
UNIVERSIT OGY
Y, ROOMA
LUCKNOW
6 BTech VI 2018 DR. A.P.J. KANPUR N 76.20
SEMESTER ABDUL INSTITUD
KALAM OF
TECHNICAL TECHONOL
UNIVERSIT OGY
Y, ROOMA
LUCKNOW
7 BTech VII 2017 DR. A.P.J. KANPUR N 71.00
SEMESTER ABDUL INSTITUD
KALAM OF
TECHNICAL TECHONOL
UNIVERSIT OGY
Y, ROOMA
LUCKNOW
8 BTech VIII 2019 DR. A.P.J. KANPUR N 76.00
Semester ABDUL INSTITUD
KALAM OF
TECHNICAL TECHONOL
UNIVERSIT OGY
Y, ROOMA
LUCKNOW
 Declaration
I INSAF ALI hereby declare that all statements in this application are true, complete and correct to the best
of my knowledge and belief. I shall be liable to a punishment in the event of providing any wrong
information. Further, I shall obey all the rules and regulations of KANPUR INSTITUTE OF
TECHNOLOGY.

Date : 26-Jan-2019
Place :

(Signature of Student)

(Authorized Signatory)
KANPUR INSTITUTE OF
TECHNOLOGY

Enclosure :
(1)Affidavit of Student for Anti-Ragging.
(2)Affidavit of Parents for Anti-Ragging.