ENGINEERING/ARCHITECTURE UG APPLICATION FORM

APPLICATION NO : 20221018916

Stage 1: Basic Details

Have You Studied From
Nationality INDIAN YES
India?
Student Aadhar Number 625314185331
Board

Stage 2: Preferences And Personal Details

Course Preference 1
Course Preference 2
Course Preference 3
MECHANICAL ENGINEERING
CIVIL ENGINEERING
COMPUTER SCIENCE AND
ENGINEERING
Specialization Preference 1
Specialization Preference 2
Specialization Preference 3
MECHANICAL ENGINEERING
CIVIL ENGINEERING
ARTIFICIAL INTELLIGENCE AND
MACHINE LEARNING

Personal Details
Name MR GOPAL RAM SEN
Mobile No. +91-7878995277
WhatsApp Number +91-9982398968
Email Id SURESHCSAIN2011@GMAIL.COM
Alternate Email ID
Date Of Birth 16/03/2005
Gender MALE
Mother Tongue
Hostel Accommodation YES
Where Do You See The Admission Advertisement NEWSPAPER
Name Of The Magazine
Name Of The Teacher/School
Name Of The Newspaper RAJASTHAN PATRIKA
Name Of The Student/ Alumni
Transport Facility Required? NO

Stage 3: Parent's And Address Details

Parent/Guardian's Details : FATHER
Father's Details Mother's Details Guardian's Details
Title MR -
Name MAHENDRA KUMAR SEN
Mobile Number +91-7023631944
Email Address MAHENDRAKSEN2011@GMAIL.COM
Occupation PRIVATE SECTOR
Designation QUALITY OFFICER
Organization Name NUVOCO CEMENT P LTD
Department Name
Bussiness Type

Address For the Communcation

Address KUMAHRO KA BAS MAIN BAZAR Pin Code : 342602
Country Name : INDIA State : RAJASTHAN District : JODHPUR City: BILARA
Stage 4: Academic Details
Current Education Qualification Status : 12TH COMPLETED
Candidate's Name As In 10th Certificate GOPAL RAM SEN

X Details
Marking Obtained Year of 10th Hall ticket
Institute Name Board Mode of Study
Scheme Percentage/CGPA Passing No./Registration No.
SARASWATI BAL
RAJASTHAN
VM SR SEC SCH
BOARD OF
KHARIYA PERCENTAGE 75.67 2020 1739110 REGULAR/FORMAL
SECONDARY
MITHAPUR
EDUCATION
JODHPUR

XI Details
Marking Obtained Year of 11th Hall ticket
Institute Name Board
Scheme Percentage/CGPA Passing No./Registration No.
SARASWATI BAL VM SR SEC
OTHER (RBSE
SCH KHARIYA MITHAPUR 2021 525448543
AJMER)
JODHPUR

XII Details
12th Hall ticket
Marking Obtained Year of
Institute Name Board Mode of Study No./Registration
Scheme Percentage/CGPA Passing
No.
SARASWATI BAL
RAJASTHAN
VM SR SEC SCH
BOARD OF
KHARIYA REGULAR/FORMAL PERCENTAGE 63.20 2022 2630902
SECONDARY
MITHAPUR
EDUCATION
JODHPUR

Address Of School/College KHARIYA MITHAPUR TEHSIL BILARA DIST JODHPUR

NAD ID/Digilocker ID
12th School Country INDIA
12th School State RAJASTHAN
12th School District JODHPUR
12th School City BILARA

Marks In Qualifying Exam (HSC) In Tamil Nadu/CBSE/Other Boards

Please select subjects/group: PHYSICS / CHEMISTRY / MATHEMATICS
Maximum Marks Obtained Marks Percentage
English 100 60 60
Language - II 100 76 76
Language - III
Maths 100 63 63
Chemistry ​100​ ​64​ ​64​
Physics ​100​ ​53​ ​53​
Biology
Computer Science
Botany
Zoology
Economics
Commerce
Business Maths and Statistics
Accounts

PCM/PCB/PMO Average Total Maximum Marks Total Obtained Marks Total Percentage
60 500 316 63.2
Other Subject Details New
Subjects Maximum Marks Obtained Marks Percentage

Marks In Qualifying Exam In Andhra Pradesh/Telengana State 12th (I And II)

Please select subjects/group :
Maximum Marks Obtained Marks Percentage
English - I
English - II
Language (II) 1
Language (II) 2
Language (III) 1
Language (III) 2
Mathematics Paper-1 (A)
Mathematics Paper-1 (B)
Mathematics Paper-2 (A)
Mathematics Paper-2 (B)
Physics paper 1
Physics paper 2
Physics paper practical
Chemistry Paper I
Chemistry Paper II
Chemistry Practical
Botany paper I
Botany paper II
Botany Practical
Zoology paper I
Zoology paper II
Zoology Practical
Other

PCM/PCB/PMO Average Total Maximum Marks Total Obtained Marks Total Percentage

Have you given JEE Main

Session Percentile Scored
exam
YES JUL 2021
Have You Given NATA Exam? NATA Session NATA Percentile Scored
NO
Have you given SAT Exam Session SAT Registration Number SAT Percentile
NO

Stage 5: Upload & Declaration

Recent Passport Size

Scanned Copy Of Your Signature
Photograph

10th Marksheet YES 11th Marksheet NO

12th Hall Ticket NO 12th Marksheet YES
NATA Scorecard NO JEE Main Scorecard NO
Aadhar Card YES SAT Scorecard NO

Declaration
Kindly note that mere submission of the admission enquiry form does not guarantee admission to any of the course in SRMIST Ramapuram
campus. Admission will be based on satisfying the eligibility criteria mandated by the University / respective statutory bodies.

Applicant Name GOPAL RAM SEN Parents Name MAHENDRA KUMAR SEN
Date 04/08/2022