INDIAN INSTITUTE OF SCIENCE, Application No

BANGALORE - 560012 19305810

APPLICATION FORM FOR ADMISSION TO
COURSE PROGRAMME (M TECH/M DES) 2019
Name of the Candidate : Mr. ANANT JAIN
(as it appears in your Degree Certificate)
Gender : Male Nationality : Indian
Category : General
Date of Birth : 05 Oct 1993 State of Domicile : Madhya Pradesh
Address for 11/275 PURNIMA BEHIND BLOCK OFFICE,
Correspondence : TILAK NAGAR,
REWA, Madhya Pradesh
PIN Code : 486001
E-mail Address : anantjain40@gmail.com
Phone Number : - Mobile Number : +91 - 7772001595
Are you Currently Employed? No
Employed Organisation : -
Designation : -
Experience Details : -
GATE Details :
Year GATE Roll GATE Paper Score (out of
Number 1000)
2017
2018
2019 IN19S45010268 Instrumentation Engineering 718
National Entrance Test Details :
National Entrance Test Year Register No. Marks (Out of
100)
CEED 2018
CEED 2019

Previous Entrance Test Details :

Preferences of Department(s) / Discipline(s):

I : MICROELECTRONICSAND VLSI DESIGN
II : INSTRUMENTATION AND APPLIED PHYSICS
III : ELECTRONIC SYSTEMS ENGINEERING
IV : -
V :-
Educational Qualification :
Schooling Year of Institution / Board % of Rank Key Subjects
Passing School Marks/
CGPA
10th Std 2009 BAL BHARATI CBSE 87.00 -
SCHOOL
REWA, REWA
12th Std 2011 BAL BHARATI CBSE 88.20 -
SCHOOL
REWA, REWA

Submitted by Mr. ANANT JAIN on Mar 21 2019 6:28PM

 Educational Qualification :
Degree (Studying Year of Institution / University Class Rank Key Subjects Sem / Marks /
/ Completed) Passing College Year GPA
BE-Electronics 2016 SGSITS INDORE Any other - 1 7.38/10
and University,MP 2 7.07/10
Instrumentation
3 7.93/10
4 8/10
5 6.73/10
6 6.87/10
7 7.67/10
8 7.93/10
9
10
Qualifying Exam : BE Status : Passed
Branch / Specialization: Electronics and Instrumentation
University : SGSITS INDORE, Any other University,MP
Year of Passing : 2016
Declaration : I Confirm that all the information which I have given in this application is complete and true to the best of my
knowledge and belief. If admitted, I will be bound by the rules and regulations of the Institute.
Place : REWA

Date : 21/03/2019 Signature of the Applicant

Submitted by Mr. ANANT JAIN on Mar 21 2019 6:28PM