MORADABAD INSTITUTE OF TECHNOLOGY REGISTRATION FORM – B.TECH. 1st YEAR 2015-16
Ref. By:
Application No.……………… (To be filled by office)
……………………………………………………………………………….. ……………………………………………………………………………….. ……………………………………………………………………………….. ………………………………………………………………………………... ………………………………………………………………………………... 5. Telephone Nos. ……………………Mobile No…….……..…………….. ……………........... 6. Date of Birth ___/___/_____Gender: M/F……..Category Gen/OBC/SC/ST)…................... 7. Appeared in UPSEE-2015 Roll No. …………….. Marks…………. Rank ………….............................. 8. Appeared in JEE Main-2015 Roll No. …………….. Marks…………. Rank …..………………………… 9. Marks in PCM in 10 + 2(Appered/Appearing) ..................... Subject Mathematics Physics Chemistry/Biology/Bio Technology Total Percentage Max Marks Marks obtained 10. Academic Details :Class Roll No. Subject Board/ Max. Marks Year Percentage University Marks Obtained th 10 10+2 1. 2. 3. 4.
Name of the Applicant Father’s Name Mother’s Name Present Address for communication
11.
Branches requested in order of Preference
12. 13.
1. 2. 3.
4. 5.
(i) ……. (iv) …… (vii) ………. (ii) …… (v) …… (viii) ……….. (iii) ……. (vi) …… (ix) ……….. Parent’s Occupation …………………………… Parent’s Annual Income ……………………….. Registration Amount Rs. 10000/- and Processing Charges Rs. 1000/- deposited by DD/Cash/NEFT……………... DD details:- Bank Name ….................………..... D.D. No. ………… Dated ……………Amount (Rs)………........ NEFT Details: Transaction No..............................Bank Name..................................................... Dated....................... D ECLARATION I hereby declare that I am applying for admission with the clear understanding that:Registration is not a guarantee for admission. Admission will be offered in the institute in different branches on the basis of merit in the UPSEE-2015/JEE-2015/ qualifying subjects in 10+2 examination, in that order / as per the directives of the UPSEE-2015 in this regard. The details of Rs. 11000/- being deposited are as under :(a) Rs. 10000/- is the Registration amount which will be adjusted against the fees incase admission is taken in this Institute in the year 2015-16 or it will be refunded if admission to any one of the branches applied for is not offered. Refund may take about one Month after the admission process is over or the date of application for cancellation whichever is later. (b) Rs. 1,000/- is the Processing Amount and is non-refundable and non adjustable. The registration amount will be forfeited, if admission offered in any of the branches applied for is not accepted by the candidate. Request for cancellation of registration and subsequent refund may not be considered in the intervening period between registration and admission.
Signature of father/Guardian as a token of having agreed with the declaration made by his son/ward
Signature of Candidate Name ……………………… Date ………………………
Name …………………………………Date …………….. Enclosures: 1. Photocopy of Marksheet of 10+2/Intermediate Examination. 2. Rank proof of UPSEE-2015/JEE Main-2015, as applicable. 3. Domicile Certificate (If Applicable). 4. Caste Certificate (If Applicable).
