Scribd
Upload
36 views2 pages

Indian Institute of Technology Delhi: Personal Details

This document contains a form for collecting personal details of students applying to the Indian Institute of Technology Delhi. The form requests information such as name, date of birth, category, blood group, gender, JEE rank, medium of instruction at school, percentage marks obtained in classes 10 and 12, father's name, mother's name, guardian's name if parents are not guardian, parents/guardian's address, history of hospitalization, medical conditions requiring treatment, nearest railway station and airport, hostel requirement, gross family annual income, bank account details, emergency contact, and declaration of local guardian for non-Delhi based students. The student is also requested to provide passport size photograph and signature.

Uploaded by

utkagra
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
36 views2 pages

Indian Institute of Technology Delhi: Personal Details

This document contains a form for collecting personal details of students applying to the Indian Institute of Technology Delhi. The form requests information such as name, date of birth, category, blood group, gender, JEE rank, medium of instruction at school, percentage marks obtained in classes 10 and 12, father's name, mother's name, guardian's name if parents are not guardian, parents/guardian's address, history of hospitalization, medical conditions requiring treatment, nearest railway station and airport, hostel requirement, gross family annual income, bank account details, emergency contact, and declaration of local guardian for non-Delhi based students. The student is also requested to provide passport size photograph and signature.

Uploaded by

utkagra
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 2

FORM A

INDIAN INSTITUTE OF TECHNOLOGY DELHI


Personal Details
1. Name of Student:
(in Hindi)
First Name

Middle Name

2. Name of Student:
(in English)
Last Name

E-mail

Mobile

3. Entry Number:

4. Blood Group:

[A, AB, B, O]

5. Sex: M/F:

4
[RH +/-]

JEE AIR

6. Category: GE/OBC/SC/ST/FN
D

7. Date of Birth

Y
1

PD: Y/N

Y
9

8. Medium of instruction at School in XIIth (Tick one)

Paste passport size


photograph

Y
3 cm x 4 cm

Hindi

9.(i) Percentage of marks in English in Class X

English

Class

Others Language___________

XII

(ii) Computer Science/ Informatics Practice was a subject in Class XII

YES

NO

If yes, Percentage of marks in Computer Science/Informatics Practice in Class XII


10. Fathers Name
E-mail
Mobile
11.Mothers Name

E-mail

Mobile

12. Guardians Name


(if parent is not guardian)
E-mail

Mobile

13. Parents/Guardians Address


(a) Permanent : ___________________________

(b) Office: _______________________________

______________________________________

______________________________________

______________________________________

______________________________________

Tel. with STD/ISD code ___________________

Tel. with STD/ISD code ___________________

Fax with ISD/STD code ___________________

Fax with ISD/STD code ___________________

E-mail: ________________________________

E-mail: ________________________________

(c) Correspondence: ________________________ _________________________________________


__________________________________________________________________________________
Tel. with STD/ISD code ___________________ Fax with ISD/STD code _______________________

14. History of Hospitalisation _____________________________________________________________


15. Are you under any regular treatment, if yes, mention prescribed medicines Yes

No

If yes, mention prescribed medicines __________________________________________________


__________________________________________________
16. Nearest Railway Station (to the current residential address)
Nearest Airport (to the current residential address)
17. Hostel:
18. Gross Family Annual Income (in Rs.)
19. Bank Account No.
State Bank of India, IIT Delhi
(If known)
(Signature of Student)
20. Declaration by parents regarding local guardian (for non-Delhi based students):
We nominate Shri/Smt. ____________________________________ relation __________________
as the local guardian for my ward. The address of the local guardian is:
Address : ________________________________________________________
________________________________________________________
________________________________________________________
Tel.No.

______________ Fax No. __________ E-mail:_________________

Please mail all performance reports and other correspondence to the address mentioned at S.No.13(a)/
13 (b)/ 13 (c)/ (20).

(Signature of Mother)

(Signature of Father)

21. Emergency Contact Person: (please tick one of the three below)
Parents as in Sl. No.13

Others: Give detail

Local Guardian as Sl. No.20


Name

: __________________________________________

Address : _________________________________________
__________________________________________
__________________________________________
Tel.No: ________________Fax No. ____________________
E-mail :________________________

Note: 1. In case of any change in address and/or telephone numbers, parents are requested to kindly intimate
the same in writing or by e-mail to the UG Section.
2. The spelling of the name written (in Hindi and English) above will appear in your degree certificate,
therefore, you are requested to kindly write your name correctly without any mistake.

You might also like