SMIT Application Form

Application No: SMIT/2021/01154

Course & Personal Details

B.TECH IN
MECHANICAL ENG.
Course UNDERGRADUATE Specialization
(ROBOTICS AND
AUTOMATION)
Personal Details
Title MR. First Name PRATYUSH DEKA Middle Name DEKA
Last Name DEKA Date of Birth 31/05/2002 Place of Birth GUWAHATI
Gender MALE Mobile Number +91-8133856520 Blood Group B+
Telephone
Email Address DEKAPRATYUSH2311@GMAIL.COM 08133856520 Nationality INDIAN
(Residence)
Category NORTH EAST Domicile ASSAM Mother Tongue ASSAMESE (ASAMIYA)
Alternate Mobile Alternate Email
Caste GENERAL +91-9365947681 PRATYUSHDEKA51@GMAIL.COM
Number Address
Candidate Aadhar
800078159257
Card No.

Parent's Details
Parent's Details PARENTS
Parent 1 Details
Title MR. Name GUNAJIT DEKA Mobile Number +91-9954300060
Relationship With
Email Address GUNAJITDEKA@GMAIL.COM Occupation PRIVATE SECTOR FATHER
Applicant
Annual Income (In
1LAKHS - 5LAKHS
Lakhs)
Parent 2 Details
Title MRS. Name TARALI DEKA Mobile Number +91-9954831514
Relationship With
Email Address TARALIDEKA2012@GMAIL.COM Occupation HOMEMAKER MOTHER
Applicant
Annual Income (In Parent Pan Card
LESS THAN 1LAKH AGDPD3803H
Lakhs) No

Address Details
Address for Correspondence
Country INDIA State ASSAM District KAMRUP
HOUSE NO. 32, BY
LANE 2, DISCOVERY KIDS SCHOOL,
City GUWAHATI Address Line 1 Address Line 2
ADARSHAPUR, KAHILIPARA
KAHILIPARA
Is Permanent
Address Same As
Pincode / Zipcode 781019 YES
Address For
Communication?
Permanent Address
Country INDIA State ASSAM District KAMRUP
HOUSE NO. 32, BY
LANE 2, DISCOVERY KIDS SCHOOL,
City GUWAHATI Address Line 1 Address Line 2
ADARSHAPUR, KAHILIPARA
KAHILIPARA
Pincode / Zipcode 781019

Academic Qualification
10th/ Equivalent Details
10th/ Equivalent Details

Major Field / Core Year of Percentage /

School Name Board Marking Scheme
Courses Passing CGPA
COUNCIL OF INDIAN SCHOOL
10th/ THE ASSAM VALLEY ALL SUBJECTS AFFILIATED
CERTIFICATE EXAMINATION 2018 PERCENTAGE 88
Eqivalent SCHOOL BY CICSE
(CISCE/ICSE)

After 10th
Equivalent 12TH
Qualification
12th / Equivalent Details
 12th / Equivalent Details

Major Field / Core Year of Result Marking Percentage /

School Name Board
Courses Passing Status Scheme CGPA
12th /
NATIONAL INSTITUTE NATIONAL INSTITUTE PHYSICS, CHEMISTRY,
Equivalent 2021 AWAITED
OF OPEN SCHOOLING OF OPEN SCHOOLING MATHEMATICS
Details

Diploma Details
Diploma Details

Major Field / Core

Institute Name Board / University Year of Passing Result Status Marking Scheme Percentage / CGPA
Courses
Diploma

Graduation Details
Graduation state Graduation University Graduation Institute
Graduation Details

College / University Discipline Specialization Year of Passing Result Status Marking Scheme Percentage/CGPA
UG

Entrance Exam Details

Have You Given
Any Entrance NO
Exam ?
Entrance Exam Details

Name of Exam Year Marks Obtained All India/State Rank Category Rank (If applicable)
1.
2.
3.
4.
5.
6.
7.

Upload Documents
Upload Your Recent Upload Your 10th
YES Upload Your Signature : YES YES
Photograph : Marksheet :

Upload Your 12th Upload Your Diploma Upload Your UG Marksheet

NO NO NO
Marksheet : Marksheet : :

Upload Your Exam

NO Upload Aadhar Card : YES Upload Parent Pan Card : YES
Certificate :

Declaration
Declaration
I HEREBY DECLARE THAT ALL THE PARTICULARS STATED IN THE APPLICATION FORM ARE TRUE TO THE BEST OF MY KNOWLEDGE AND BELIEF. I HAVE READ AND UNDERSTOOD ALL THE PREVIOUS
OF ADMISSION AND AGREE TO ABIDE THEM. IN THE EVENT OF FRAUDLENT, INCORRECT OR FALSE INFORMATION OR SUPPERSSION OD DISTORTION OF ANY FACT LIKE EDUCATIONAL
QUALIFICATION, MARKS, NATIONALITY ETC., I UNDERSTAND THAT MY ADMISSION/DEGREE IS LIABLE FOR CANCELLATION. I FURTHER UNDERSTAND THAT MY ADMISSION IS PURELY PROVISIONAL
SUBJECT TO THE VERIFICATION OF THE ELIGIBLE CONDITION.

PRATYUSH DEKA DEKA

Applicant Name Parent Name GUNAJIT DEKA Date 08/03/2021
DEKA