3/19/22, 11:42 AM BITSAT 2022 Application Form :: Bits, Pilani

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Birla Institute of Technology & Sciences, Pilani
BITSAT-2022
ONLINE APPLICATION FORM

Application Number: 22116327

Personal Details :

Full Name : SHIKSHA SINHA

Gender : FEMALE

Date of Birth : 16-DEC-2004

Father's Name : LATE DHANANJAY KUMAR

Mother's Name : MANISHA KUMARI

Father's Mobile No : 9031383457

Nationality : INDIAN

Email-Id : shikshasinha2211@gmail.com

Address : LH-1204
AMRAPALI VILLAGE
NYAY KHAND-2
INDIRAPURAM

City : GHAZIABAD - 201014

State : UTTAR PRADESH

Land line no. : 1203550160

Mobile No. : 9625406212

Academic Details :
Name of the Institution
Examination
Name of Examination
Board
: PRESIDIUM INDIRAPURAM
: 12th CLASS (or) ITS EQUIVALENT
: CENTRAL BOARD OF SECONDARY EDUCATION - ALL INDIA SENIOR
SCHOOL CERTIFICATE EXAMINATION [CBAT]

Year of Passing : 2022

Subject selected for Part IV : MATHEMATICS
of BITSAT
BITSAT Online Test Options : 1st Session
Test Center Preferences : Preference 1 : NOIDA
Preference 2 : GHAZIABAD
Preference 3 : DELHI

Payment Details:- Application fee paid through online mode (PayTM) with the below particulars.
Transaction Number Transaction Date Transaction Amount (INR)

20220319111212800110168791221591998 19-03-2022 2900.00

Declaration: I hereby declare that all particulars given in this application form are true to the best of my knowledge
and belief. I have read and understood all the instructions for appearing in BITSAT-2022. I shall abide by the terms
and conditions of BITSAT-2022.

* Do not post this application to BITS, Pilani.

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3/19/22, 11:42 AM BITSAT 2022 Application Form :: Bits, Pilani

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