MORADABAD INSTITUTE OF TECHNOLOGY (Constituent College of MIT Group of Institutions) REGISTRATION FORM – B.TECH. 1st YEAR 2016-17 Application No.……………… (To be filled by office)
……………………………………………………………………………….. ……………………………………………………………………………….. ………………………………………………………………………………... ………………………………………………………………………………... ……………………Mobile No…….……..…………….. ……………........... ___/___/_____Gender: M/F……..Category Gen/OBC/SC/ST)…................... Appeared (Yes/No) Roll No. …………………Marks…………. Gen. Combined Rank …………............. Appeared (Yes/No) Roll No. …………………Marks…………. Gen. All India Rank …..………………
1. 2. 3.
Name of the Applicant Father’s Name Present Address for communication
4. 5. 6.
Telephone Nos. Date of Birth UPSEE-2016 If Yes,
7.
JEE Main-2016 If Yes,
8.
Marks in qualifying subject in 10+2 (Roll No………………………….. .Board…………………Year……….....)
Subject Max Marks
Mathematics
Physics
Chemistry/Biology/Bio Technology
Total
Percentage
Marks obtained
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
4. 5.
(vii)
……….
10.
3.
(iv) (v) (vi)
…… …… ……
Branches requested in order of Preference
1. 2.
(i) (ii) (iii)
……. …… …….
9.
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) only against the management quota seats/vacant UPSEE-2016 quota seats on the basis of merit in the UPSEE-2016/JEE-2016/ qualifying subjects in 10+2 examination, in that order / as per the directives of the UPSEE2016 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 2016-17 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 fee 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 ward)
Signature of Candidate Name ……………………… Date ………………………
Name …………………………………Date …………….. Enclosures: 1. Photocopy of Mark sheet of 10+2/ Intermediate Examination. 2. Rank proof of UPSEE-2016/JEEMain-2016, as applicable.
MORADABAD INSTITUTE OF TECHNOLOGY (Constituent College of MIT Group of Institutions) REGISTRATION FORM – B.TECH. 2nd YEAR (LATERAL ENTRY) 2016-17 Application No.……………… (To be filled by office)
……………………………………………………………………………….. ……………………………………………………………………………….. ………………………………………………………………………………... ………………………………………………………………………………... ……………………Mobile No…….……..…………….. ……………........... ___/___/_____Gender: M/F……..Category Gen/OBC/SC/ST)…................... Appeared (Yes/No) Roll No. …………………Marks…………. Gen. Combined Rank …………........................
1. 2. 3.
Name of the Applicant Father’s Name Present Address for communication
4. 5. 6.
Telephone Nos. Date of Birth UPSEE-2016 If Yes,
Academic Details: Class
Roll No.
Subject/ Branch
Board/ University
Max. Marks
Marks obtained
Year
Percentage
B.Sc /Diploma
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
4. 5.
(vii)
……….
8.
3.
(iv) (v) (vi)
…… …… ……
Branches requested in order of Preference
1. 2.
(i) (ii) (iii)
……. …… …….
7.
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-2016 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 2016-17 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 fee 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 ward )
Signature of Candidate Name ……………………… Date ………………………
Name …………………………………Date …………….. Enclosures: 3. Photocopy of Mark sheet of Diploma examination/ B.Sc. examination 4. Rank proof of UPSEE-2016 as applicable.
