Ref. By: MORADABAD INSTITUTE OF TECHNOLOGY REGISTRATION FORM – B.TECH. 2nd YEAR (LATERAL ENTRY) 2015-16
Application No.……… (To be filled by office)
1. 2. 3. 4.
Name of the Applicant Father’s Name Mother’s Name Present Address for communication
5. 6.
Telephone Nos. Date of Birth
……………………………………….................…....................... ........….. ………………………………….................…................................……….. ………………………………….................................................………….. ...…………………………………….................................................……... ...…………………………………….................................................……... ………………….........…Mobile No….........................……................…… ___/___/_____ Gender: M/F…….. Category (Gen/OBC/SC/ST)….................
7.
Appeared in UPSEE-2015
Roll No. ……...........….. Marks……........……. Rank ................................
8.
Academic Details :Class
Roll No.
Subject
Board/ University
Max. Marks
Marks Obtained
Year
Percentage
10th 10+2 B.Sc/ Diploma (i) (ii) (iii)
……. …… …….
(iv) (v) (vi)
…… …… ……
(vii) (viii) (ix)
………. ……….. ………..
9.
Branches requested in order of Preference
10. 11.
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 E C L A R A T I O N
1. 2. 3.
4. 5.
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-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 2015-2016 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
Signature of Candidate Name ………………………………… declaration made by his son/ward Date ………………………………… Name …………………………………Date …………….. Enclosures: 1. Photocopy of Mark sheet of B.Sc./Diploma Examination.. 2. Rank proof of UPSEE-2015, as applicable. 3. Domicile Certificate (If Applicable). 4. Caste Certificate (If Applicable). as a token of having agreed with the
