4/4/2020 Course Examination Form

National Institute of Electronics and Information Technology

Ministry of Electronics and Information Technology, Government of India

O LEVEL ONLINE EXAMINATION FORM - JULY, 2020

Application Number Application Date & Time For Office Use Only
Demand Note No. 5790854

EOIT0720001465 04-Apr-2020 10:59:54 AM Demand Note Date 04-Apr-2020

Batch No.

1. Applicant's Personal Details / आवेदक का गत िववरण

Applicant's Full Name / आवेदक का पूरा नाम Mr.Ravi Ratna
Father's/Guardian's Name / िपता/अिभभावक का नाम Mr. Shravan Kumar
Mother's Name / माता का नाम Mrs. Radha
Date of Birth / ज िदनां क (dd/mm/yyyy) 15-Mar-1995
2. Registration Details / पंजीयन का िववरण
Registration No. / पंजीकरण सं ा 1167650
Course Name / कोस का नाम O LEVEL
Candidate Type / उ ीदवार का कार Direct Candidate
3. Contact Details / संपक िववरण
Phone with STD code / दू रभाष एस टी डी कोड सिहत
Mobile Number / मोबाइल नंबर 9695805438
Email Address / ईमेल पता ravi.ratna.tiwari@gmail.com
4. Correspondence Address / प ाचार का पता
Address / पता block colony , near civil court, diwani road
mainpuri
District:- Mainpuri,
State:- Uttar Pradesh, Pin:- 205001
5. Exam Details / परी ा का िववरण
Exam Name / परी ा का नाम July, 2020
Exam Centre First Choice / परी ा क पहला िवक UPETW (Etawah)
Exam Centre Second Choice / परी ा क दू सरा िवक UPAGR (Agra)
Improvement/इ ूवमट No
Modules Appearing / मॉ ूल दे ने 01. M2-R4 INTERNET TECHNOLOGY AND WEB DESIGN
02. M3-R4 PROGRAMMING AND PROBLEM SOLVING THROUGH C LANGUAGE
Practicals Appearing / ै कल दे ने NA
6. Fee Details / शु िववरण
No. of Modules X Fee/Module / मॉ ूल की सं ा X शु /मॉ ूल (2 x 750.00) 1500.00
No. of Practicals X Fee/Practical / ै कल की सं ा X शु / ै कल 0.00
Exam Form Processing Fees / परी ा फाम का सं रण शु 100.00
Late Fees(if applicable) / िवलंब शु (यिद लागू हो) 0.00 (Not Applicable)
Total Fees / कुल शु One Thousand Six Hundred Rupees Only 1600.00
8. Payment Detail
Applying This Exam As Direct Candidate
Application Examination Fee will be Deposited by Candidate
Payment Mode: CSC SPV
Transaction no. of payment receipt ा टां जे न सं ा दज कर NA
Note * : Please don't send this form without making payment./कृपया इस फाम को भुगतान के िबना नही ं भेज
Note *: Please pay examination fee through available payment options and after making payment submit this form for institute verification to the institute mentioned
above in the form. /कृपया भुगतान के िलए उपल िवक ों म से िकसी एक का चयन करके परी ा शु का भुगतान कर ऊपर विणत सं थान को स ापन के िलए परी ा फाम ुत कर |
Note *: Last date of payment of examination fee / परी ा शु का भुगतान की अंितम तारीख: 08-May-2020
7. Declaration / घोषणा
I Ravi Ratna S/oShravan Kumar registered as a Direct Candidate hereby declare that, all the particular stated in the application, are true to the best of my knowledge and belief. I
hereby certify that I have applied the aforesaid checks before submitting the Online Examination Form. I have read and understood all the instructions available on the site. I agree to
abide by the rules and regulations of the NIELIT and also to the decision of the Examination Authority, on any issue related to my admission to the Examination. I have noted that the
Examination Authority has the right to withhold my result ever after appearing in the Examination in addition to any other action as may be deemed fit in the event of any of the
statements made above being found incorrect or my candidature being found ineligible at a later date. I have specially gone through the eligibility criteria laid down by NIELIT for
appearing in different examinations and I confirm that I fullfill the eligibility for the Theory & Practical modules, I have applied for.

Left hand thumb impression / बाएं हाथ के अंगूठे का िनशान Signature of Applicant/ ह ा र

https://student.nielit.gov.in/CAND/ExamFormPreview.aspx?qs=smO0iafNqHKjNxzwGBXFC4IU7nymYN8Z4swR7voo6C7O7rjn6gxhVQ== 1/1