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BIRLA INSTITUTE OF TECHNOLOGY & SCIENCE,

PILANI (RAJASTHAN)
Application for Admission to Integrated First Degree
Programmes (Except B.Pharm)at BITS, Pilani in 2023-24.
(Pilani campus, Goa campus and Hyderabad Campus)

Application Number: 23111897

Revised Application Form

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Part I

Full Name TATTWAM SAMUI

Gender MALE
Date of birth(dd-mm-yyyy) 08-JAN-2005
Father's name ABHIJIT SAMUI
Mothers's name BRATATI SARKAR
Address TAJ PAHARPUR APARTMENTS NALINI RANJAN AVENUE BLOCK
TAJ PAHARPUR APARTMENTS

KOLKATA - 700053
Phone Number 9647856894 / 9647856894
Email tattwam48@gmail.com
Nationality INDIAN
Parent’s/Guardian Mobile Number 8981088834
Parent’s/Guardian Email Address jit_sam@yahoo.com
Aadhar Card Number 470550919827
Blood Group B+
Deographic Information

Category GENERAL
Religion HINDU
School attended in class 12th PRIVATE
Medium of instructions at school ENGLISH
Physically Handicapped NO
Occupation of Father/Guardian SALARIED JOB PRIVATE
Occupation of Mother SALARIED JOB GOVT
Area you belongs to URBAN
Your parents’ total annual income ABOVE 15 LAKH
If you have already joined a programme, Name of the College/University:
Part II

Name of Institution presently DELHI PUBLIC SCHOOL RUBY PARK, KOLKATA

studying in /last attended:
Examination
Name of examination board
Year of passing/appearing
12th
CENTRAL BOARD OF SECONDARY EDUCATION - ALL INDIA SENIOR
SCHOOL CERTIFICATE EXAMINATION [CBAT]
2023

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Date on which 12 th exam

12-MAY-2023
result declared
Marks in the subjects taken
Marks Maximum
in 12thexam. Subjects %
obtained marks
Physics (P) 79 100 79.00
Chemistry (C) 95 100 95.00
Mathematics (M) 95 100 95.00
English (E) 95 100 95.00

Total aggregate marks in

Obtained: 455 Out of: 500
12th exam
Aggregate percentage of
91.00
marks in 12 th examination
Note: The Institute considers only the latest performance through a public examination for
admission. If the results of the latest examination are not available within the due date for
submission of application, the candidate will not be considered even if there are some earlier
performances of 12th class or its equivalent or any higher examination available with him/her. If a
candidate has taken more than one attempt in 12th class or its equivalent, only his latest
performance is considered, provided this attempt has been for the full component of
subjects/courses prescribed. Improvement in only few subjects will not be accepted.
Please ensure that the above marks entered by you are in accordance with the above note.

Application No: 23111897

Part III

The programme chosen by you in the order of your preferences are given below.

1 . B.E. Computer Science - [Pilani Campus]

2 . B.E. Computer Science - [Goa Campus]
3 . B.E. Computer Science - [Hyderabad Campus]
4 . B.E. Electronics & Communication - [Pilani Campus]
5 . B.E. Electronics & Communication - [Goa Campus]
6 . B.E. Electronics & Communication - [Hyderabad Campus]
7 . B.E. Electrical & Electronics - [Pilani Campus]
8 . B.E. Electrical & Electronics - [Goa Campus]
9 . B.E. Electrical & Electronics - [Hyderabad Campus]
10 . B.E. Electronics & Instrumentation - [Goa Campus]
11 . B.E. Electronics & Instrumentation - [Hyderabad Campus]
12 . M.Sc. Economics - [Pilani Campus]
13 . M.Sc. Economics - [Goa Campus]
14 . M.Sc. Economics - [Hyderabad Campus]
15 . M.Sc. Physics - [Pilani Campus]
16 . M.Sc. Physics - [Hyderabad Campus]
17 . B.E. Mechanical - [Pilani Campus]
18 . B.E. Mechanical - [Hyderabad Campus]
19 . M.Sc. Mathematics - [Pilani Campus]
20 . M.Sc. Mathematics - [Hyderabad Campus]
21 . M.Sc. Chemistry - [Pilani Campus]
22 . M.Sc. Chemistry - [Hyderabad Campus]
23 . M.Sc. Biological Sciences - [Pilani Campus]

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24 . M.Sc. Biological Sciences - [Hyderabad Campus]

25 . B.E. Chemical - [Pilani Campus]
26 . B.E. Chemical - [Hyderabad Campus]
27 . B.E. Civil - [Pilani Campus]
28 . B.E. Civil - [Hyderabad Campus]
29 . M.Sc. Physics - [Goa Campus]
30 . B.E. Mechanical - [Goa Campus]
31 . M.Sc. Biological Sciences - [Goa Campus]
32 . M.Sc. Chemistry - [Goa Campus]
33 . M.Sc. Mathematics - [Goa Campus]
34 . B.E. Electronics & Instrumentation - [Pilani Campus]
35 . B.E. Manufacturing - [Pilani Campus]
36 . B.E. Chemical - [Goa Campus]

Declaration by the Applicant:

I have carefully read the Instructions and I hereby declare that all the information given and statements made
in this application and also in its accompanying attachments and enclosures are true to the best of my
knowledge. I agree to the condition that if any information or any statement is found to be wrong, my admission
to the Institute would automatically be cancelled.
If admitted, I promise to abide by the rules and regulations in force or those that may hereafter be made by the
administration of the Institution and I shall do nothing either inside or outside the institution which will interfere
with its orderly working and discipline. In all matters concerning me and the institution, its hostels, Practice
School stations, etc. the decision of the Vice-C hancellor shall be binding on me.

Application Number: 23111897

Declaration by Father/Mother or Guardian:

I ABHIJIT SAMUI do solemnly affirm that I shall be responsible for the discipline and conduct of my
son/daughter/ward and pay regularly all his/her expenses during his/her stay in the institute.

Application fee payment paid through challan.

Application Number: 23111897

Application Submitted on 6/27/2023 12:06:57 PM
* Note: You do not need to send the hard copy of this form to BITS, Pilani. However, you can keep a
printed copy of this form for your future references. You should not share your online credentials
(login, and password) with anyone for security reasons

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