APOLLO INSTITUTE OF TECHNOLOGY

APOLLO INSTITUTE OF TECHNOLOGY

VILLAGE - SUNDHELA, BLOCK - SARSAUL,
KANPUR ALLAHABAD HIGHWAY, N.H.-2,

COLLEGE REGISTRATION FORM - Institute Copy

(Provisional, subject to the compliance of Rules/Regulation of Dr. A.P.J. Abdul Kalam Technical
University)
B.TECH (PRE-ENROLLED STUDENTS): 2022-23

IMPORTANT : Candidates should fill the entries very carefully.

UNIVERSITY ROLL NO. (URN) : 2003530109023

Name of Course & Branch : BACHELOR OF TECHNOLOGY(COMPUTER SCIENCE AND

ENGINEERING)
Year : 4
Semester : 8
Status of Student : Regular
Name of Student: SACHIN PRAJAPATI
(As per High school Certificate in English)

Name of Student:
(In Hindi)

Father's Name : RAM JIWAN PRAJAPATI

(As per High school Certificate)

Occupation : others Annual Income : 60000.00

Mother's Name : CHANDRAKANTI PRAJAPATI
(As per High school Certificate)

Date of Birth : 15-Oct-1996

Category (GEN/OBC/SC/ST) : OBC
Permanent Address : 102-A SURENDRA NAGAR
RAWATPUR
KANPUR
UTTAR PRADESH
INDIA
Pincode : 208019
Local Address : 102-A SURENDRA NAGAR
RAWATPUR
KANPUR
UTTAR PRADESH
INDIA
Pincode : 208019
Student Mobile No. : 7080213350
Student Email Id : sachin96on@gmail.com
Parents Mobile No. : 9956136278
Parents Email Id:

Qualification Details
S.No. Qualification Passing Year Board/Univers Institute/Colle Highest Percentage
ity ge Qualification
1 DIPLOMA 2021 BOARD OF OTHER N 73.63
TECHNICAL
EDUCATION
, UP
LUCKNOW
2 HIGH 2011 BOARD OF SARASWATI N 75.30
SCHOOL HIGH GYAN
SCHOOL MANDIR
AND INDIRA
INTERMEDI NAGAR
ATE UTTER KALYANPU
PRADESH R
3 INTERMEDI 2014 BOARD OF SHRI N 68.20
ATE HIGH RAMLALA
SCHOOL INTER
AND COLLEGE
INTERMEDI RAWATPUR
ATE UTTER KANPUR
PRADESH

Declaration
I SACHIN hereby declare that all statements in this application are true, complete and correct to the best of
my knowledge and belief. I shall be liable to a punishment in the event of providing any wrong
information. Further, I shall obey all the rules and regulations of APOLLO INSTITUTE OF
TECHNOLOGY.

Date : 24-Jan-2023
Place :

(Signature of Student)

(Authorized Signatory)
APOLLO INSTITUTE OF
TECHNOLOGY

Enclosure :
(1)Affidavit of Student for Anti-Ragging.
(2)Affidavit of Parents for Anti-Ragging.
 APOLLO INSTITUTE OF TECHNOLOGY
APOLLO INSTITUTE OF TECHNOLOGY
VILLAGE - SUNDHELA, BLOCK - SARSAUL,
KANPUR ALLAHABAD HIGHWAY, N.H.-2,

COLLEGE REGISTRATION FORM - Student Copy

(Provisional, subject to the compliance of Rules/Regulation of Dr. A.P.J. Abdul Kalam Technical
University)
B.TECH (PRE-ENROLLED STUDENTS): 2022-23

IMPORTANT : Candidates should fill the entries very carefully.

UNIVERSITY ROLL NO. (URN) : 2003530109023

Name of Course & Branch : BACHELOR OF TECHNOLOGY(COMPUTER SCIENCE AND

ENGINEERING)
Year : 4
Semester : 8
Status of Student : Regular
Name of Student: SACHIN PRAJAPATI
(As per High school Certificate in English)

Name of Student:
(In Hindi)

Father's Name : RAM JIWAN PRAJAPATI

(As per High school Certificate)

Occupation : others Annual Income : 60000.00

Mother's Name : CHANDRAKANTI PRAJAPATI
(As per High school Certificate)

Date of Birth : 15-Oct-1996

Category (GEN/OBC/SC/ST) : OBC
Permanent Address : 102-A SURENDRA NAGAR
RAWATPUR
KANPUR
UTTAR PRADESH
INDIA
Pincode : 208019
Local Address : 102-A SURENDRA NAGAR
RAWATPUR
KANPUR
UTTAR PRADESH
INDIA
Pincode : 208019
Student Mobile No. : 7080213350
Student Email Id : sachin96on@gmail.com
Parents Mobile No. : 9956136278
Parents Email Id:

Qualification Details
S.No. Qualification Passing Year Board/Univers Institute/Colle Highest Percentage
ity ge Qualification
1 DIPLOMA 2021 BOARD OF OTHER N 73.63
TECHNICAL
EDUCATION
, UP
LUCKNOW
2 HIGH 2011 BOARD OF SARASWATI N 75.30
SCHOOL HIGH GYAN
SCHOOL MANDIR
AND INDIRA
INTERMEDI NAGAR
ATE UTTER KALYANPU
PRADESH R
3 INTERMEDI 2014 BOARD OF SHRI N 68.20
ATE HIGH RAMLALA
SCHOOL INTER
AND COLLEGE
INTERMEDI RAWATPUR
ATE UTTER KANPUR
PRADESH

Declaration
I SACHIN hereby declare that all statements in this application are true, complete and correct to the best of
my knowledge and belief. I shall be liable to a punishment in the event of providing any wrong
information. Further, I shall obey all the rules and regulations of APOLLO INSTITUTE OF
TECHNOLOGY.

Date : 24-Jan-2023
Place :

(Signature of Student)

(Authorized Signatory)
APOLLO INSTITUTE OF
TECHNOLOGY

Enclosure :
(1)Affidavit of Student for Anti-Ragging.
(2)Affidavit of Parents for Anti-Ragging.