4/5/2019 MTECH/MSD/2019/0502

Application for M.Tech. Programme

APPLICATION NUMBER : MTECH/MSD/2019/0502 APPLIED ON : 05-04-2019

1. Full name of the Applicant MR. SUBHASH PATEL

2. Type Institute Assistantship

3. Programme in which admission is sought Mechanical Systems Design
4. Name of the Mother RAJJAN DEVI
5. Ocupation of the Mother HOUSE WIFE

6. Name of the Father SANT RAM PATEL 7. Occupation of the Father LABOUR
8. Date of Birth of Candidate 10-07-1996 9. Nationality INDIAN
10. Marital Status UNMARRIED 11. Gender MALE
12. Category OBC 13. Religion HINDU
14. PWD NO
15. Whether applied previously for the same program in IIT Bhubaneswar? NO 16. COAP Reg ID COAP19021043
17. Address Details
Address for Correspondance Permanent Address
CHAINI KA PURA CHAINI KA PURA
LALGOPAL GANJ LALGOPAL GANJ
ALLAHABAD ALLAHABAD
Uttar Pradesh Uttar Pradesh
PIN: 229413 PIN: 229413
Email: subhash10796@gmail.com Email: subhash10796@gmail.com
Cell Number: 7206638537 Cell Number: 7206638537
18. Educational Qualification
Examination University/Institute Year Subjects/ Discipline/ Specialization Division/Class Percentage CGPA
Passed
HSC SMT BDIC 2010 NA 2 51.16
HS SMT BDIC 2012 PHYSICS,CHEMISTRY,MATHEMATICS,HINDI,ENGLISH 1 67.2
DELHI COLLEGE
OF TECHNOLOGY
B.Tech. 2018 MECHANICAL ENGINEERING 1 79.86
AND
MANAGEMENT
19. Performance in GATE
Discipline Year of Examination GATE Reg.No. Subject Code Score AIR (All India Rank) Validity
MECHANICAL ENGINEERING 2019 ME19S15026871 ME 709 2299 2022
20. Experience, if any, of Service and/or Research including Present Postion held
Name and Address of Employer Designation From To Total Nature of Work Salary Remarks
(mm/yyyy) (mm/yyyy) Period Draw
(mm/yy) (in INR)
NA NA / / 00/00 NA NA NA
21. Details of any Research/Professional Experience/Publication in Journals.
NA
22. LIST OF ENCLOSURES
(1) METRIC (2) INTERMEDIATE (3) MARKSHEET 1of 3 (4) MARKSHEET 2of3 (5) MARKSHEET 30f 3 (6) GATE SCORE
CARD (7) PROVISIONAL
23. Application Fee Payment Details
Fee Amount Payment Mode Payment Date Payment Reference No.
300 On-Line Payment 05-04-2019 DUB1342175

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4/5/2019 MTECH/MSD/2019/0502

Place: _______________
Date: ________________
Signature of the Applicant

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