INDIAN INSTITUTE OF TECHNOLOGY DELHI

FORM "A" APPLICATION

Personal Details
Name of Student RAHUL KUMAR MEENA Entry Number 2022CET2443
Date of Birth 22-05-1996 Gender Male (M)
Blood Group O+ Adhaar Number 299299494214
PAN Number Nationality India
Person with Yes Email rahulkmeena22@gmail.com
Disability
Mobile No. 8145809171 Full/ Part Time Full-Time
Bank Account No 33968221981 Emergency 7665071898
Contact No.
Bank Name State Bank Of India Guardian's KAMLU LAL MEENA
Name
Emergency 121, MEENA COLONY, UDAI MODE, Status Code
Address GANGAPUR CITY, DISTRICT- SAWAI
MADHOPUR (RAJASTHAN)

121, MEENA COLONY , UDAI Address 121, MEENA COLONY , UDAI

MODE MODE

Country India Country India

State Rajasthan State Rajasthan
City GANGAPUR CITY City GANGAPUR CITY

Parent's Personal Details

Father's Name Occupation Aadhaar No. PAN No. Contact Email Office Address
KAMLU LAL Retired AMO 121, Meena Colony,
MEENA Udai Mode,
Gangapur City,
Dist.- Sawai
Madhopur,
Rajasthan, (PIN
322201)
Mother's Name Occupation Aadhaar No. PAN No. Contact Email
SAROJ DEVI Housewife
Office Address
121, Meena Colony,
Udai Mode,
Gangapur City,
Dist.- Sawai
Madhopur,

Rajasthan, (PIN
322201)
Academic Record

Degree Institute Name Discipline Name Exam Year Percentage

score Max Score

Higher Secondary (10+2)RBSE

or equivalent SCIENCE MATH 2013 78.80 394 500

B.Tech/BE/B.Sc Engg. (4
IITyears)
KHARAGPUR CIVIL ENGINEERING
2019 64.9 6.49 10

Employment Details

Organization Designation From Period To Period Roles Total Pay

I RAHUL KUMAR MEENA Entry No. 2022CET2443 hereby declare that the information completed by me on this form
is true and correct to the best of my knowledge. I also undertake that in case the information and documents submitted by
me is/are found to be incorrect, my candidature/admission is liable to be cancelled.

Student Signature