Phone : 91-080-68188111/8135

R V Educational Institutions
Fax : -
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RV College of Engineering Website : www.rvce.edu.in

(Autonomous Institution Affiliated to VTU, Belagavi) Email ID : [email protected]

Approved by All India Council for Technical Education, New Delhi Address : R.V.Vidyanikethan Post,
Mysuru Road,
Bengaluru-560059
Application form for Admission to B.E Program for the Academic year

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Program : Branch :

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Admission No : Quota :

Student No. : Allotted Category :

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Aggregrate Marks in PUC :
Receipt No. Amount Date

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Aggregrate Marks in PCM : (in Rs)

Photograph

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KEA / COMED_K / MNGT Fee

Principal Account Fee

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RVCE Fee-1

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RVCE Fee-2

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STUDENT'S PERSONAL DETAILS n
Name of the candidate
(As per PUC / 12th Standard
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Marks card)
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First Name : Middle Name : Last Name :

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Gender : Date of Birth : Place of Birth :

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Country of Birth : State of Birth : Domicile :

Nationality : Religion : Caste :

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Aadhar No : Blood Group : Mother Tongue :

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Differently Percentage of Disability

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Abled : Disability : Certificate No :

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Mobile Number : IFSC Code :

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Contact Number with

STD / ISD Code: Saving Bank Account No. :
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Email ID : Hostel Requirement : NO

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Local City /
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State :
District :
Address
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Details Country : Pin Code :

Permanent City /
State :
District :
Address
Details Country : Pin Code :

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 FAMILY INFORMATION

Name : Occupation :

Name of the
Father's Organization : Designation :
Details
Email ID :
Contact no : AADHAR:

Mobile Parent's
PAN Number : Number : Annual Income :

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Father's City /
State :
District :
Address

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Country : Pin Code :

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Name : Occupation :

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Name of the
Mother's Organization : Designation :
Details

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Contact no: Mobile Number : AADHAR:

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PAN Number : Email ID :

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Mother's City /
State :
District :
Address

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Country :
n Pin Code :

Guardian Name : Occupation :

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Details If
Contact number with
Applicable Email ID :
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STD / ISD Code :

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Relationship with Mobile

Parent / Student : Number :
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Guardian's City /
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State :
District :
Address
Country : Pin Code :
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ENTRANCE EXAM DETAILS

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Quota : Exam taken : Round :

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Entrance
Register Admission
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Exam No : Rank : Order /SL. No. :

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Admission Seat Claimed Allotted Category

Order Category (including mode) :
Date : (including mode) :
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 QUALIFYING EXAMINATION DETAILS

Name of the
Examination : 10TH Board :

Register No. : Name of the School:

Qualifying Total Marks Marks Obtained

Exam

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Details Month and Year of
% or CGPA :

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Passing :

Qualifying Month and Year of

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Exam Passed : Passing :

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Name of the College
Register No. : last attended :

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Name of the State :
Board :

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PUC Marks PUC- PUC- PUC-

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Physics : Chemistry : Mathematics :
and
PCM Percentage :
Percentage PCM Total : PUC Total :

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PUC Percentage :
Interest in Extra Curricular
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Activities if any (Sports, Cultural
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& Other Activities) :
Has any of your Family member studied / studies in RVCE? If Yes, Provide details.
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Name of the
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Person : Batch : Program :

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Relation : Mobile Number : Email ID :

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Present Working
Details / Name of the Address of the
Designation / USN (if Organization : Organization :
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studying currently) :
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I / We agree that the information furnished is true to the best of my / our knowledge and if the
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information provided is false, then appropriate action may be initiated against us as deemed fit.
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Signature of the
Candidate Signature of the Parent / Guardian
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Date :
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FOR OFFICE USE ONLY

The applicant Mr. / Ms. ______________ward of _____________is admitted to B.E in ______________________
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program under ________________________ quota during the academic year _______________ .

Verified by 1. Name : _____________________ Signature : ______________

Verified by 2. Name : _____________________ Signature : ______________

Signature of Principal
All SC / ST / OBC students are required to submit scholarship form by October every year or as per Notification

RAGGING IS A NON-BAILABLE CRIMINAL OFFENCE

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 MEMORANDUM OF UNDERTAKING
I / We Mr. / Mrs. VIJAYENDRA parent / guardian and the candidate Mr. / Ms. _______________ seeking admission to B.E in
_______________ program of RV College of Engineering , during the academic year _______________ , hereby undertake

1)
a. To abide by all Rules and Regulations prescribed by the management of Rashtreeya Sikshana Samithi Trust (RSST), Jayanagar,
Bangalore-11, Visvesvaraya Technological University (VTU), Belagavi, University Grants Commission(UGC), New Delhi, All India Council
for Technical Education (AICTE) and R V College of Engineering, Bengaluru - 560059
b. To abide by all the rules pertaining to attendance and Continuous Internal Evaluation (CIE) requirements prescribed by the
University/Institution for the purposes of seeking eligibility to appear for the Semester End Examination(SEE) requirements.
c. That the candidate will not create or assist or even associate himself/herself in any activities which disturbs or likely to disturb the

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peace and smooth working of the institution or hostel including involvement or encouraging in brawls/smoking/drugs/ alcoholic

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drinks. Any form of gambling /betting /hawking /misuse of IT resources like internet/intranet/social media/software, inappropriate
celebrations and any other disruptive activities. In such cases, I understand that, I may be liable to be dismissed from the institution and /
or the hostel with immediate effect and mandatorily comply with other institutional rules and regulations of the institution.

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d. To submit ourselves to the disciplinary inquiry and /or any type of control that might be exercised by the Management/Institution
to facilitate the compliance of the institutional policy.

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e. To abide by the panel action that might be initiated by the Management/College authorities aganist me in the event of myself
involving and indulging in any subversive activities.

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f. Not to seek transfer to any other college or surrender the seat or to seek transfer to any other course after the last date of admission
__ to complete the course in the institution. If for any unforeseen circumstances, such a request is made after _________ ,
i.e. - _____________and

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the student will be liable to pay the balance course fee in full for the complete period of the course/program.
g. That the candidate Mr./Ms _______________ shall not indulge in ragging activities and we are aware that

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ragging is a non-bailable criminal offence. If I am found involved in ragging directly or indirectly, I can be dismissed from the college and
the hostel with immediate effect, and the entire fee paid may be forfeited.
h. That the candidate will not carry and use mobile phone in the Academic area as per the norms of University and college.

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i. That the candidate will strictly follow the dress code specified by the college as given in the hand book from time to time.
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j. That the institute will have the right to withdraw or cancel any Certificate of Character/Conduct issued to me for the purpose of
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loan/scholarship/passport etc. by writing to the concerned authorities, if I am found violating any of the Institutional rules and regulations.
k. That Mr./Ms _______________ shall not indulge in copying/malpractice during both internal and end semester
examinations and plagiarization during submission of seminar papers/assignments/minor and major project reports. If found to be
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involved, I may be disqualified to take up further examinations and will be liable for dismissal from the Institution and the hostel with
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immediate effect and all the fee paid may be forfeited.

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l. That any ailment with past medical history will be intimated in advance with necessary records, as and when required.
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2) We are aware that

a. The college will not be responsible for any mis-happening, if students individually or in group, organize pleasure trips/tours without the
prior permission of the college authorities.
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b. The candidate Mr./Ms _______________ shall have to satisfy attendance requirement and Continuous Internal
Evaluation (CIE) requirements as a condition precedent for seeking eligibility to appear for the Semester End Examination (SEE).
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c. The day scholar/boarder will be solely responsible for any untoward incidences occurring because of his/her involvement either in the
campus,hostel or outside the campus.
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d. This admission is purely subject to approval by the Visvesvaraya Technological University (VTU), Belagavi, Karnataka and Government of
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Karnataka.
e. The Principal has the power to expel the candidate from the college and the hostel, if found guilty of not abiding by the rules and
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regulations laid down by the college/university/other statutory bodies.

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Signature of the Candidate Signature of the Guardian Signature of the Parent

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Name :
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Date :

All SC / ST / OBC students are required to submit scholarship form by October every year or as per Notification

RAGGING IS A NON-BAILABLE CRIMINAL OFFENCE

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