Application form for Integrated M.Tech.

Programmes
( 2019 - 20 )

Application No.

2019822044
Candidate Name : OBURI NAGA SAI KUMAR
Date of Birth 10-06-2002 Gender MALE
Religion Hinduism Nationality Indian
Blood group O+ Mother Tongue Telugu
Community General/OC Native state Andhra Pradesh
Mobile No. 9491337715 Email ID. saikumaroburi@gmail.com
Parent name Oburi Adhi Narayana Hostel required Yes
Mode of study Regular Medium of Instruction English
Qualifying Exam 12th Class Month & Year passing Mar - 2019
Exam Roll no. 1905236092 Choice of Campus Chennai
Maximum Marks 10.0 Obtained Marks 9.00
PCM Marks Physics : 20 Chemistry : 15 Mathematics : 18
Name of the Board ANDHRA PRADESH BOARD OF INTERMEDIATE EDUCATION
Permanent Address Door No :3-135/ Oburi vari street, Velpur, Near Savalyapuram, Guntur, Andhra Pradesh-522646
Address of the school Gudavalli, Vijayawada, Krishna, Andhra Pradesh-521104
DECLARATION
I solemnly and sincerely affirm that I am Indian National / PIO/OCI Holder and that all particulars furnished by me in this application form are true and correct.
I have not concealed any information.However, in the event of any information being found to be incorrect, fraudulent or untrue, either before or after the
examination or after my admission to the programme, i understand that I am liable to face criminal prosecution and the management can claim all authority to
cancel my candidature / selection or admission as the case may be and I would have to forgo my seat and the fees.I will pay the required Tuition fees and the
Hostel fees within the stipulated time to ensure my admission in Vellore Institute of Technology (VIT). I agree to abide by the rules and regulations governing
the conduct examination as well as the rules pertaining to the refund of Tuition and Hostel fees as per VIT norms & status. I further undertake to submit all the
required certificates as per the rule, either at the time of counseling or admission process, failing which I understand that I would have to forego my seat and the
fees. I accept the method for Merit List preparation by VIT. I understand that all information related to VIT application form will be sent through the valid
mobile number/registered email. I am also aware of the refund policy that the counseling processing fee of Rs.6,000/- is non-refundable.

Signature of the candidate

Payment Acknowledgment Copy

Name of the service provider Techprocess Payment Gateway

Payment Option Made Netbanking/Credit/Debit Card

Application No. 2019822044

Candidate name OBURI NAGA SAI KUMAR

Transaction No. 803430711

Application Fee Rs. 850.00

Transaction Date & Time 18-05-2019 11:59:21