Admission Application Form 2021 - 2022

Application No: GCET20219639

Applicant Details
Course Details
GCET (B.TECH, MBA, B.TECH COMPUTER SCIENCE
Entry Type REGULAR Select Campus Preference 1
MCA) AND ENGINEERING
B.TECH COMPUTER
B.TECH COMPUTER SCIENCE
SCIENCE AND For Official Use
Preference 2 AND ENGINEERING (ARTIFICIAL Preference 3
ENGINEERING (DATA Only
INTELLIGENCE)
SCIENCE)
B.TECH COMPUTER SCIENCE
Office Use Only 1 Campus Hidden CET202
AND ENGINEERING
Personal Details
Title MISS First Name SURABHI Middle Name
Last Name AGNIHOTRI Mobile Number +91-8924967521 Email Address RAGNIHOTRI1973@GMAIL.COM
Date of Birth 28/04/2002 Blood Group B+ Gender FEMALE
Nationality INDIAN Category GENERAL Aadhar Number 806886327382
Religion HINDUISM Place of Issue Date of Issue
Date of Expiry Hidden Date 31/12/2020

Parents Details
Father Details
Father Mobile
Father Title MR Father Name SUBODH AGNIHOTRI +91-8922948458
Number
Father Email GOVERNMENT
SAGNIHOTRI410@GMAIL.COM Father Occupation
Address SECTOR
Mother Details
Mother Mobile
Mother Title MRS Mother Name RASHMI AGNIHOTRI +91-8924967521
Number
Mother Email
RAGNIHOTRI1973@GMAIL.COM Mother Occupation HOMEMAKER
Address

Address Details
Address for Correspondence
Country INDIA State UTTAR PRADESH District KANNAUJ
QUARTER NO COLLECTRATE COLONY
City KANNAUJ Address Line 1 Address Line 2
5,TYPE2,BLOCK 1 SARAIMEERA KANNAUJ
Is Permanent
Address Same As
Pincode 209725 YES
Address For
Communication?
Permanent Address
Country INDIA State UTTAR PRADESH District KANNAUJ
QUARTER NO COLLECTRATE COLONY
City KANNAUJ Address Line 1 Address Line 2
5,TYPE2,BLOCK 1 SARAIMEERA KANNAUJ
Pincode 209725

Academic Details
Educational Qualifications
10th Academic Details

Institute Name Board Year of Passing Marking Scheme Obtained Percentage/CGPA

CENTRAL BOARD OF SECONDARY EDUCATION
10th ST XAVIER SCHOOL KANNAUJ 2018 PERCENTAGE 91.4
(CBSE)

After 10th Qualification 12TH 12th Result Status DECLARED Select Stream PCM
12th Academic Details

Institute Name Board Year of Passing Marking Scheme Obtained Percentage/CGPA

CENTRAL BOARD OF SECONDARY EDUCATION
12th ST XAVIER SCHOOL KANNAUJ 2020 PERCENTAGE 94.6
(CBSE)

PCM percentage 95 PCB Percentage

 Diploma Details

Institute Name Course Name Year of Passing Result Status Marking Scheme Obtained Percentage/CGPA
Diploma

UG Details

Institute Name Course Name Year of Passing Result Status Marking Scheme Obtained Percentage/CGPA
UG

Upload Documents
Upload your Documents

Upload Your Recent Upload Your Upload Your 10th

YES
Photograph : Signature : Marksheet :

Upload Your 12th Upload Your PG Upload Your Diploma

YES NO NO
Marksheet : Marksheet : Marksheet :

Marksheet received Upload Your

Upload Your Aadhaar
till last sem/year NO YES Character Certificate YES
Card :
(Percentage/ CGPA) : :

Upload Your
Upload Your Transfer Upload Your Domicile
YES Migration Certificate YES YES
Certificate : Certificate :
:

Declaration
Declaration
I HEREBY DECLARE THAT THE PARTICULARS GIVEN IN THE APPLICATION FORM ARE TRUE AND CORRECT AND THEY WILL BE SUPPORTED BY ORIGINAL DOCUMENTS WHEN ASK FOR I AM ALSO
FULLY AWARE THAT IN THE GIVEN INFORMATION BEING FOUND INCORRECT OR MISLEADING, MY CANDIDATURE SHALL BE LIABLE TO CANCELLATION BY INSTITUTE AT ANY TIME.

Applicant Name SURABHI AGNIHOTRI Parent Name SUBODH AGNIHOTRI Date 16/09/2021