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U-G Online Application Form :: Bits, Pilani

C lick h ere to P rin t th is page.

Last date of Receipt: 5.00 PM on 31th March 2024 BITS, PILANI

Application for Admission to U-G Programmes
Programme: U-G

Appl No.: 930150

Full Name : ANKIT KUMAR
Gender : Male Dob: 01 JAN 2006
Father's name : MANTU SINGH
Mother's name : GITA DEVI
Nationality : Indian
Email Id : ankit960805@gmail.com
Address : Front of Mahavir Mandir

VILL - KAITHI , P.O - KAITHI

P.S - CHAUTHAM

DIST - KHAGARIA

City : GUWAHATI
State : BIHAR
Contact Number : 8676975955
Mobile Number : 87892 56359
Programme Applied for : B-TECH
Campus Preferences for U-G
Campus Preferences : Pref1: PILANI Pref2: ­ Pref3:­
Have you ever been on the : No
rolls of BITS as a regular
student
Presently Employed : NO

Highest Qualifying Examination: HD

Name of the Degree : 10+2 Higher Secondary Course
University / Institution : KOSHI COLLEGE, KHAGARIA
Subject / Discipline : PCM
Aggregate % of Marks/CGPA : 70.8
Year of Passing : 2023
Academic Record
Aggregate%
Degrees/ Year of
University / Institution of Division Subject/ Discipline
Diplomas Passingon
marks/CGPA

10+2 Higher KOSHI COLLEGE, PCM

Secondary 2023 2 70.8 First
KHAGARIA
Course

ADELAIDE CONVENT HIN, ENG,

Matric 2021 1 SCHOOL, SAMPACHAK, 79.4 First MAT, SCI,
PATNA SST

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11/22/2016 PhD Online Application Form :: Bits, Pilani

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11/22/2016 B-Tech Online Application Form :: Bits,niPilani

Appl No.: PH930150

Have you cleared any of the following examination:

CSIR­NET: No GATE: No GPATE: No Any Other:

Name of the Department

Under which wish to Pursue C-S
B-Tech in BITS:

Payment Details

Payment: Application fee payment through online payment and transaction id is : 272643508

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11/22/2016 PhD Online Application Form :: Bits, Pilani
Appl No.: 930150

If employed tick one of the options:

I would be sponsored by the I would come on full I would terminate the employment if
employee leave selected
Awards like Merit Scholarships, Gold Medal, NSTS, NTS, etc. that you have received:
______________________________________________________________________
If you have done any BITS Higher degree or its equivalent (M.E., M.Pharm., M.S., M.Phil. etc.), give details:
(a) Name of the Degree: ______________________________________________

(b) Name of the

Institution:__________________________________________________________________

(c) Duration: From___________________To___________________

(d) Part­time or full­time?____________________________________

(e) Name of courses and marks (%) or grades obtained (Attach syllabi of all courses, if degree is not of BITS).

S.No. Course Name Percentage Marks/Grades Prescribed Text Book

10

If you have applied for any other degree programme of BITS, give

(a) Application No.:________________________________

(b) Name of degree:____________________________________

If you have ever been a Ph.D. student,

(a) Name of the Institution:_______________________________________________________

(b) Duration: From______________________________To______________________________

(c) Research topic and

supervisor:_______________________________________________________________________

(d) Fellowship (agency and

amount):_______________________________________________________________________

(e) Reasons for

discontinuing:_______________________________________________________________________

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11/22/2016 PhD Online Application Form :: Bits, Pilani
Appl No.: 930150

Have you ever appeared in a Ph.D. qualifying examination at BITS? Yes No

If Yes,
(a) ID No:_______________________________

(b)Dates of Examination: (dd/mm/yyyy)______________________________

(c) Result: Pass Fail

Attach separate sheets giving (i) details of Technical publications/patents (Give title, name(s) of the
author(s) and journal in which appeared) and (ii) Professional Attainments & Distinctions.
Declaration by father or guardian (or employer in case of sponsored candidates): I do solemnly affirm that
I shall be responsible for the discipline and conduct of my son/daughter/ward/employee and pay regularly
all his/her expenses during his/her stay in the Institute.

Place:____________________________________Signature:_______________________________

Date:____________________________________Name:_______________________________

Designation:_______________________________

Address(in case of employer):____________________________________

Declaration by the Applicant: I hereby declare that 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
for the administration of the Institution and I shall do nothing which will interfere with its orderly working
and discipline. In all matters concerning me and the institution, its hostel, Practice School stations, the
decision of the Vice­chancellor shall be binding on me.

Place:____________________________________Signature:_______________________________

Date:____________________________________Name:_______________________________

Permanent Address:____________________________

PSRN (applicable to BITS faculty only):_______________________________

Enclosures relevant to Part I ?

(a) Proof of date of birth

(b) Challan Copy / Online Fee receipt

(c) Photo copy Mark sheet and certificate of qualifying degree

(d) Syllabus of Higher degree courses, if holding a higher degree

(e) Any other, specify__________________________________________

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