ADVANCE REGISTRATION FORM – B.TECH. 2nd YEAR (Lateral Entry) Application No. ………………
MORADABAD INSTITUTE OF TECHNOLOGY APPLICATION FOR ADVANCE REGISTRATION FOR ADMISSION TO B.TECH. DEGREE COURSE 2nd YEAR (Lateral Entry) FOR THE SESSION 2013-2014 1.
Name of the Applicant
……………………………………………………………
2.
Father’s Name
……………………………………………………………
3.
Mother’s Name
……………………………………………………………
4.
Permanent Resident of & Its Address
…………………………………………………………… …………………………………………………………… ……………………………………………………………
5.
Present Address for communication
…………………………………………………………… …………………………………………………………… ……………………………………………………………
6.
Telephone Nos.
……………………………………………………………
7.
Mobile Nos.
……………………………………………………………
8.
Email ID
……………………………………………………………
9.
Date of Birth
……………………………………………………………
10.
Gender
……………………………………………………………
11.
Category (Gen/OBC/SC/ST)
……………………………………………………………
(Self Attested Copy of Caste Certificate to be attached for OBC/SC/ST) 12.
Parent’s Occupation
……………………………………………………………
13.
Parent’s Annual Income
……………………………………………………………
14.
Name of the Board awarding Diploma
……………………………………………………………
15.
Branch of Diploma
……………………………………………………………
16.
Marks in Diploma Examination
…………………………………
Total
(Self Attested Copy of marksheet to be attached) Percentage 17.
Name of the University awarding B.Sc. Degree
18.
Subjects in 10+2 Examination.
19.
Marks in B.Sc. Examination
………………………………….………………
…………………………………………………………… …………………
Total
…………………
(Self Attested Copy of marksheet to be attached) % 20.
…………………………………
Academic Details :-
Class 10th 10+2 B.Sc/ Diploma
Roll No.
Subject
Board/ University
Max. Marks
Marks Obtained
Year
Percentage
21.
If Diploma examination passed from an institution outside of U.P then is Domicile Certificate of Father/Mother Available ? ……………………………………………. (If Yes, Self Attested Copy of Domicile Certificate to be attached)
22.
Branches requested in order of
(i)
………………. (vi)
………………..
preference
(ii)
………………. (vii)
………………..
(iii)
………………. (viii)
………………..
(iv)
………………. (ix)
………………..
(v)
……………….
23.
Appeared in UPSEE-2013 for admission Roll No. …….……… Marks…….……. Rank ……….….…..
in 2nd year in 2013-14 24.
1. 2.
3.
4. 5.
Registration Amount Rs. 10,000/- deposited vide (Bank details) ………………………… …………………………………….. DD No. ……………….... dated …………………. and Processing Charges Rs. 1,000/- deposited vide (Bank details) ……………………… ………………………… DD No. ……………….... dated ………………… both in favour of Moradabad Institute of Technology, Moradabad. D E C L A R A T I O N 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 three year Diploma examination/basis of merit in B.Sc. examination / as per the directives of the UPSEE-2013 in this regard. The details of Rs. 11,000/- being deposited are as under :(a) Rs. 10,000/- is the Registration amount which will be adjusted against the fees incase admission is taken in this Institute in the year 2013-2014. Rs. 10,000/- will be refunded if admission to any one of the branches applied for is not offered. It may take about two weeks after the admission process is over. (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 of Rs. 10,000/- may not be considered in the intervening period between registration and admission.
Signature of father/Guardian
Signature of Candidate
as a token of having agreed with the
Name …………………………..
declaration made by his son/ward
Date …………………………..
Name ……………………………… Date ……………………………… Enclosures :
1.
Photocopy of Mark sheet of B.S.C./Diploma Examination.
2.
Demand Drafts bearing No. ……………….. dated ………………for Rs. 10,000/- (Ten Thousand Only) and DD No. ………………… dated ………………. for Rs. 1,000/- (Rupees One thousand only) both in favour of Moradabad Institute of Technology, payable at Moradabad.
3.
Caste Certificate (If Applicable).
4.
Domicile Certificate (If Applicable).
5.
Rank proof of UPSEE 2013/JEE Main 2013, as applicable.
