DIRECTORATE OF TECHNICAL EDUCATION

KAHILIPARA, GUWAHATI - 781019

CHOICE FILLING FOR COUNSELLING PROCESS FOR
POLYTECHNIC ADMISSION(BASED ON PAT-2023)
SUBMITTED ON - 04-07-2023 12:48:00
ACKNOWLEDGEMENT SLIP

REGISTRATION DETAILS
PAT ROLL NUMBER CANDIDATE'S NAME DATE OF BIRTH
3110330 NAYEEM IQBAL 13-08-2006
FATHER'S NAME MOTHER'S NAME EMAIL ID
NURUL ISLAM RUNUMA BEGUM NAYEEMIQBAL.2006@GMAIL.COM
GENDER CATEGORY NATIONALITY
MALE GENERAL INDIAN
RELIGION MOBILE NUMBER ALTERNATE MOBILE NUMBER
ISLAM 8638704012 9394293879
COMMUNICATION DETAILS
PERMANENT ADDRESS
S/O NURUL ISLAM VILLAGE : JAGARA PO: JAGARA
POLICE STATION DISTRICT STATE PINCODE
BELSOR PS NALBARI ASSAM 781310
CORRESPONDENCE ADDRESS
S/O NURUL ISLAM VILLAGE : JAGARA PO: JAGARA
POLICE STATION DISTRICT STATE PINCODE
BELSOR PS NALBARI ASSAM 781310

QUALIFICATION DETAILS
INSTITUTE NAME BOARD YEAR OF PASSING
DREAMLAND ENGLISH SCHOOL NARAYANPUR SEBA 2023
MARKS OBTAINED TOTAL MARKS PERCENTAGE HSLC ROLL NUMBER
444 600 74.00 % B23-06610-308
SUBJECT OBTAINED IN THEORY OBTAINED IN PRACTICAL TOTAL MARKS
ENGLISH 78 10 88
SCIENCE 62 10 72
MATHEMATICS 73 10 83
OVERALL % SCIENCE/MATHEMATICS 77.50

QUESTIONARIES
ARE YOU SON/DAUGHTER OF A CENTRAL GOVT. EMPLOYEE? NO
ARE YOU A PERMANENT RESIDENT OF ASSAM? YES
DO YOU HAVE TSLC PASS CERTIFICATE FROM SCTE BOARD? NO
DO YOU BELONG TO TUITION FEE WAIVER SCHEMES? NO
ARE YOU GRANDSON/GRAND-DAUGHTER OF A FREEDOM FIGHTER? NO
ARE YOU SON/DAUGHTER OF A RETIRED DEFENCE PERSON? NO
ARE YOU A NCC CADET? NO
ARE YOU A SPORTSMAN? NO
ARE YOU PERSONS WITH DISABILITIES (PWD)? NO
HAVE YOU PASSED YOUR QUALIFYING EXAMINATION WITHOUT GRACE MARKS IN MATHEMATICS & SCIENCE? YES
HAVE YOU SUCCESSFULLY COMPLETED YOUR QUALIFYING EXAM IN SINGLE SITTING? YES

PREFERENCES
PREFERENCE INSTITUTE PROGRAMME
PREFERENCE - 1 ASSAM ENGINEERING INSTITUTE, GUWAHATI COMPUTER ENGINEERING
PREFERENCE - 2 ASSAM ENGINEERING INSTITUTE, GUWAHATI CHEMICAL ENGINEERING
PREFERENCE - 3 ASSAM ENGINEERING INSTITUTE, GUWAHATI ELECTRICAL ENGINEERING
PREFERENCE - 4 ASSAM ENGINEERING INSTITUTE, GUWAHATI MECHANICAL ENGINEERING
PREFERENCE - 5 NALBARI POLYTECHNIC, CHANDKUCHI COMPUTER SCIENCE & ENGINEERING
PREFERENCE - 6 NALBARI POLYTECHNIC, CHANDKUCHI ELECTRICAL ENGINEERING
PREFERENCE - 7 KAMRUP POLYTECHNIC, BAIHATA CHARIALI ELECTRONICS & TELECOMMUNICATION ENGINEERING
PREFERENCE - 8 KAMRUP POLYTECHNIC, BAIHATA CHARIALI MECHANICAL (AUTOMOBILE) ENGINEERING
PREFERENCE - 9 KAMRUP POLYTECHNIC, BAIHATA CHARIALI ELECTRICAL ENGINEERING
PREFERENCE - 10 NALBARI POLYTECHNIC, CHANDKUCHI PRINTING TECHNOLOGY
PREFERENCE - 11 BARPETA POLYTECHNIC, BARPETA BIO-MEDICAL ENGINEERING
PREFERENCE - 12 MORIGAON POLYTECHNIC, MORIGAON MEDICAL ELECTRONICS

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 PREFERENCE - 13 NOWGONG POLYTECHNIC, NAGAON COMPUTER ENGINEERING
PREFERENCE - 14 NOWGONG POLYTECHNIC, NAGAON MECHANICAL ENGINEERING
PREFERENCE - 15 NOWGONG POLYTECHNIC, NAGAON ELECTRICAL ENGINEERING
PREFERENCE - 16 NOWGONG POLYTECHNIC, NAGAON CIVIL ENGINEERING
PREFERENCE - 17 BONGAIGAON POLYTECHNIC, BONGAIGAON MECHANICAL (AUTOMOBILE) ENGINEERING
PREFERENCE - 18 BARPETA POLYTECHNIC, BARPETA MECHANICAL ENGINEERING
PREFERENCE - 19 MORIGAON POLYTECHNIC, MORIGAON ELECTRICAL ENGINEERING
PREFERENCE - 20 ASSAM ENGINEERING INSTITUTE, GUWAHATI ELECTRONICS & TELECOMMUNICATION ENGINEERING

DOCUMENTS
AGE PROOF UPLOADED
HSLC OR EQUIVALENT MARKSHEET UPLOADED
PERMANENT RESIDENCE CERTIFICATE (PRC) UPLOADED
I hereby declare that all information given in this application are true, complete and correct to the best of my knowledge and belief.i understand that in the
event of any information being found false or incorrect at any stage or not satisfying any of the stipulated eligibility criteria, my candidature is liable to be
cancelled.

SIGNATURE

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