Annexure

OFFICE OF THE DEAN ACADEMIC

1. Name of the Applicant:

2. Registration No.
3. Details of examination (B. Tech (Hons.)) passed at NIT Jamshedpur -
Semester Month and year of Examination held SGPA CGPA
st
1 Semester
nd
2 Semester

4. Name of current branch/allotted at the time of admission:

5. List of Branch in order of preference (for change of branch)

Sl. No. List of branches sought in order of preference

1
2
3
4
5
6

6. AIR in JEE main (Attach proof) :

7. Details of student admitted category:
(a) PwD : YES/NO
(b) State/All India :
(c) UR/OBC/SC/ST :

I submit that the details furnished above are true and correct. In case of any information
found to be incorrect at any stage my branch sliding will be cancelled and I will have no
grievances against the same. I understand that the branch once allotted by the Institute shall
be final and cannot be reversed.

Date: Signature of the student

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Verified his/her CGPA. The student is eligible for change of branch. Forwarded for
necessary processing.
Name of the Faculty Advisor:

Signature

Date Signature of the HOD

Change of branch allo

rd

Previous Roll New Roll No.

No.

PI-Admission Associate Dean (Academic) Dean Academic