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Application Form for M.Tech./M.Pharm.

Programme

Application No.: 19102731


Date & Time of Submission: 2019-04-03 11:32:39.616639

1. Personal Information

FULL NAME : NILESH SINGHAL


MOTHER's NAME : MINAKSHI SINGHAL
FATHER's NAME : ASHISH SINGHAL
Date of Birth : 1997-08-11
Email : nileshsinghal1@gmail.com Gender : M
Nationality : Indian Category : GEN
Physically Challenged ? :N
Mobile Number : 7251865776
Correspondence Address: 18, Chatta Mohalla, Delhi Gate, Ghaziabad, UP - 201001
Permanent Address : 18, Chatta Mohalla, Delhi Gate, Ghaziabad, UP - 201001
State : Uttar Pradesh
COAP Registration No.: COAP19014505

2. Application Fee Details


Application Fee : 500
E-receipt no. : DUB1213318
Date of Payment : 03-04-2019

3. Programme Selection :
Registration Category : Full-Time Regular

3A. Select the Primary Programme you are applying for (Compulsory) :
Programme : M.Tech
Department/School: Department of Civil Engineering
Discipline: Civil Engineering
Spec 1:ENGINEERING GEOSCIENCES
Spec 2:NA
Spec 3:NA
Spec 4:NA
Spec 5:NA
Spec 6:NA
Spec 7:NA
3B. Additional Programme 1 : 3C. Additional Programme 2 :
Programme : M.Tech Programme : null
Dept/School:Department of Mechanical Engineering Dept/School: null
Discipline: Industrial Management Discipline: null
Spec 1:NA Spec 1:null
Spec 2:NA Spec 2:null
Spec 3:NA Spec 3:null
Spec 4:NA Spec 4:null
Spec 5:NA Spec 5:null
Spec 6:NA Spec 6:null
Spec 7:NA Spec 7:null

Spec = Specialization
4. Details of GATE/GPAT (Mandatory for Full-Time Regular Category) :

GATE/GPAT Qualified : Yes Is Your GATE/GPAT Score Valid : Yes


Name of the Exam : GATE
Reg./Rollno. PE19S48009096
Exam discipline : Petroleum Engineering
Exam Year : 2019
Exam Rank : 144
Exam Score : 64
5. Academic Details :
5A. Qualifying Degree details : 5B. Other Degree details :
Degree : UG Degree Degree :
Degree Status : Appearing Degree Status :
Degree Name : BTech Degree Name :
University : University of Petroleum and University
Energy Studies :
Discipline : Applied Petroleum Engineering Upstream :
Discipline
Exam Year : 2019 Exam Year :
% or CGPA : 7.157 % or CGPA :
5C. Intermediate (10+2):
Name of Certificate : Intermediate
Name of Board : ISC
Subjects : Science, Java, English
Year of Passing : 2015
Final Aggregate % or CGPA: 88.4
5D. High School (10th):
Name of Certificate : High School
Name of Board : ICSE
Subjects : Science, Java, History & Civics, English, Hindi, EVS
Year of Passing : 2012
Final Aggregate % or CGPA: 84.4

6. Work Experience(Mandatory if applying under sponsored category):


First Work Experience : Second Work Experience :
Period from : Period from :
Period to : Period to :
Organization : Organization :
Position : Position :

7. Declaration:
I declare that the information provided by me on this application form is correct to the
best of my knowledge and belief. I understand that any wilful misinterpretation of facts
will result in my disqualification and dismissal from the Institute if admitted.

Candidate signature

Application no.: 19102731


Date & Time of Submission: 2019-04-03 11:32:39.616639