ser23, 1:20PM BITSAT 2028 Application Form «Bits, Plan Birla Institute of Technology & Sciences, Pilani Application Numbe BITSAT-2023 ONLINE APPLICATION FORM ssiea0e7 IM Personal Detal Full Name Gender Date of Birth Father’ Name Mother's Name Father's Mobile No Nationality Email-Id Address City State Land line no. Mobile No. Academic Details : Name of the Institution Examination Name of Examination Board Year of Passing of BITSAT BITSAT Online Test Options Test Center Preferences : NEW MODEL ENGLISH SCHOOL ANDJUNIOR COLLEGE KOLHAPUR : MAHARASHTRA STATE BOARD OF SECONDARY AND HIGHER SECONDARY : 2023, Subject selected for Part IV : : Both ist and 2nd Sessions SHIVENDRA SHRIKANT PATIL MALE 14-FEB-2005 SHRIKANT SHUBHANGT “Lc 9619064664 INDIAN shivendrapatil14@gmai ‘A202 AJMERA TREON , BHAKTI PARK , WADALA EAST’ MUMBAI - 400037 MAHARASHTRA 7620804742 12th CLASS (or) ITS EQUIVALENT EDUCATION - HIGHER SECONDARY CERTIFICATE EXAMINATION [MSBT] MATHEMATICS Preference 1 : KOLHAPUR Preference 2 : MUMBAI Preference 3 : PUNE Payment Details:~ Application fee paid through online mode (PayTM) with the below particulars, ‘Transaction Number Transaction Date _| Transaction Amount (INR) 20230308010440000840367990842776533 08-03-2023 5400.00 Declaration: I hereby declare that all particulars given in this application form are true to the best of my knowledge and belief. 1 have read and understood all the instructions for appearing in BITSAT-2023. I shall abide by the terms and conditions of BITSAT-2023. ew l NU \ hitps:tsat chexams.convbtsat2028appIs itAppform aspx? skey=BITS 1678208036559 DINTERNATIONAL 1678296038559APPLICATION, ”