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Application Form 24221006116

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mdmustak4737
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62 views

Application Form 24221006116

Uploaded by

mdmustak4737
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
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SCIENCE AND HUMANITIES 2024 UG APPLICATION FORM

APPLICATION NO : 24221006116

Program And Campus Preference


SRM IST DELHI NCR CAMPUS,
Campus Preference 1 Program Preference 1 BCA Specialization Preference 1 DATA SCIENCE
GHAZIABAD (UP)
Campus Preference 2 Program Preference 2 Specialization Preference 2
Campus Preference 3 Program Preference 3 Specialization Preference 3

Personal Details
Nationality INDIAN
Have you Studied 10th and 12th from India ? YES
Student Aadhar No.
Full Name (As Per The Qualifying Examination
MD IKLAKHUL
Certificate)
Mobile No. +91-9267943021
WhatsApp Mobile Number +91-9267943021
Email ID [email protected]
Alternate Email ID
Date Of Birth 01/01/2006
Gender MALE

Parent Details
Father Mother Guardian
Title MR
Name MD CHAND BABU
Mobile Number +91-9871780253
Email Address

Address Details
Address : HAROLA SECTOR 5 NOIDA Pin Code : 201301
District : GAUTAM BUDDHA
Country Name :INDIA State : UTTAR PRADESH City: NOIDA
NAGAR

Academic Details
Current Education Qualification Status : 12TH COMPLETED
X Details XII Details
Institute Name RJ INTER HIGH SCHOOL G.I.COLLEGE
CENTRAL BOARD OF SECONDARY
Board /University U.P. BOARD OF HIGH SCHOOL AND INTERMEDIATE EDUCATION
EDUCATION (CBSE)
Marking Scheme PERCENTAGE PERCENTAGE
Percentage / CGPA 59.80 59
Year Of Passing 2022 2024
Registration Number 0764553 11/1100/11/22/0179
Mode of Study REGULAR REGULAR
NAD ID/Digilocker ID
Address Of School/College BARAULA NOIDA GAUTAM BUDHA NAGAR

Payment Details
Transaction ID 113268325492
Payment Date 29/04/2024
Mode Of Payment Unified Payments
Declaration
I certify that the information submitted by me in support of this application, is true to the best of my knowledge and belief. I understand that
in the event of any information being found false or incorrect, my admission is liable to be rejected / cancelled at any stage of the program. I
undertake to abide by the disciplinary rules and regulations of the institute.

I hereby declare that I have gone through the eligibility criteria as given in the link below. I am fully aware that, If I do not meet the eligibility
criteria, any provisional admission given to me during the counselling period will be forfeited.
Https://Www.Srmist.Edu.In/Admission-India/Science-And-Humanities/

Applicant Name : MD IKLAKHUL

Parent/Guardian Name : MD CHAND BABU

Date : 29/04/2024

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