Application Form

Application No: STL-2023-1028

Applicant Details
Basic Details
B-TECH CSE SOFTWARE
Course University GD GOENKA, GURGAON Title MR
ENGINEERING
First Name MOHIT Middle Name Last Name RAJPUT
Email address RAJPUTG5059@GMAIL.COM Mobile Number +91-9728850585 Date of Birth 01/01/2005
Gender MALE Nationality INDIAN Aadhar Card Number 905539607414
Blood Group B+ Category GENERAL
Passport Details
Passport Number Country Place of Issue
Date of Issue Date of Expiry

Parent Details
Father's Details
Father's Mobile
Father's Title MR Father's Name HOSHIAR SINGH +91-9467736892
Number
Father's Email
MB8109696@GMAIL.COM Father’s Occupation PRIVATE SECTOR
Address
Mother's Details
Mother's Mobile
Mother's Title MRS. Mother's Name KANTA DEVI +91-9306071261
Number
Mother's Email
RAJPUTG5059@GMAIL.COM Mother's Occupation HOMEMAKER
address
Guardian Details
Guardian Title Guardian Name Guardian Phone No.
Guardian Email ID

Address Details
Address for Correspondence
Country INDIA State HARYANA District PALWAL
KALYAN ENCLAVE KALYAN ENCLAVE
City PALWAL Address Line 1 COLONY BEHIND Address Line 2 COLONY NEAR ROCK
PAPPAN PLAZA ARCADE
Is Permanent Address
Pincode 121102 Same As Address For YES
Correspondence?
Permanent Address
Country INDIA State HARYANA District PALWAL
KALYAN ENCLAVE KALYAN ENCLAVE
City PALWAL Address Line 1 COLONY BEHIND Address Line 2 COLONY NEAR ROCK
PAPPAN PLAZA ARCADE
Pincode 121102

Educational Qualification Details

Education Details
10th Details

School Name Board Year of Passing Marking Scheme Obtained Percentage/CGPA

10th DHARAM PUBLIC SCHOOL CENTRAL BOARD OF SECONDARY EDUCATION (CBSE) 2021 PERCENTAGE 67

After 10th
12TH
Qualification
12th Details

Year of Obtained Maximum Obtained

School Name Board Result Status Marking Scheme
Passing Marks Marks Percentage/CGPA
DHARAM CENTRAL BOARD OF
12th PUBLIC SECONDARY 2023 DECLARED PERCENTAGE 333 500 66.60
SCHOOL EDUCATION (CBSE)
 Diploma Details

Institution Year of Result Marking Obtained Maximum Obtained

University Branch
Name Passing status Scheme Marks Marks Percentage/CGPA
Diploma

UG Details

Year of Result Marking

Institution Name University Obtained Marks Maximum Marks Obtain Percentage/CGPA
Passing Status Scheme
UG

Have You
Appeared In Any
NO
Entrance
Examination ?
Exams Details

Exam Exam Roll No. Year of Appearing Result Status Score/Percentile All India Rank
1
2
3

Upload Documents
Upload Documents

Upload Student Upload 10th

Upload Signature : YES
Photo : Marksheet :

Upload 12th Upload Diploma Upload Your UG

YES NO NO
Marksheet : Marksheet : Marksheet :

Upload Entrance
Examination NO Upload Adhar card : YES
Marksheets :

Declaration
Declaration
I CERTIFY THAT THE INFORMATION SUBMITTED BY ME IN SUPPORT OF THIS APPLICATION, IS TRUE TO THE BEST OF KNOWLEDGE AND BELIEF. I UNDERSTAND THAT IN THE EVENT OF ANY
INFORMATION BEING FOUND FALSE OR INCORRECT, MY ADMISSION IS LIABLE TO BE REJECTED / CANCELLED AT ANY STAGE OF THE PROGRAM. I UNDERTAKE TO ABIDE BY THE DISCIPLINARY RULES
AND REGULATIONS OF THE INSTITUTE.

checkbox I AGREE Applicant Name MOHIT RAJPUT Parent Name HOSHIAR SINGH
Date 13/07/2023