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M-TECH Admission Form

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bibhidipan88
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22 views2 pages

M-TECH Admission Form

Hi

Uploaded by

bibhidipan88
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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[Emergency Phone No. : PROVISIONAL ADMISSION te Paste your 2 recent passport size lege ID No" photograph HALDIA INSTITUTE OF TECHNOLOGY ‘Approved By : Al ndia Counel for Technical Educallon & Afisted To: MAKAUT (Formerly known as WBUT) ADMISSION FORM FOR PG 1.a) Course: in, 2, Name (In Block Letter) 3.a) EmaillD: (b) Ph. No (Student). ¢) Aadhaar No. (Student) : __ 4) PAN No. (Student) : 4. Admitted through MAT/ JEMAT/JECA/GATE /PGET/ Roll No. core/Rank___ Name of Father: Name of Mother: Mobile No. of Guardian 11. Occupation of Mother: am Income of Mother io vil ___. Police Station = PINCode___ State, 15. Permanent Address : House /Flat No. a) Vill__ PO: ae Police Station. District: ____PINCode "State, 16. Date of Birth (As per School Final Admit Card ): i 17. Religio 18. Caste: General/SC/STIOBC___19. Sex: Male/Female 20. Blood Group 21. Name & Address of School / College / University of which student studied last : |. Relationship with Gi 10. Occupation of Fé Annual Income 22. Academic details (submit attested copies of mark sheet) Exami- | Yearof Name of Board/ nation | Passing ‘Council / Sub. Over-all | Passed! University % Divn, 10th 12th UG PG contd... p/2 gee DECLARATION | shall scrupulously abide by the Institute Standing Orders and do everything in my power to enhance the feputation and honour of the institute and profession for which | am commencing my studies. | shall not commit any dishonorable act & shall not take in any subversive activities including ragging in any form Inside or outside of the campus. | undertake to pay Institute and hostel fees regularly in due time. any incident of ragging comes to the notice of the authority, | shall be given liberty to explain and if any ‘explanation is not found satisfactory, the authority would expel me from the institution. | also understand that there will be no refund of fees if | discontinue my studies for any reason after starting of the academic session. | declare that the information given above are true and correct to the best of my knowledge and belief. (Signature of Father/Mother/guardian with date) Signature of Student with date For Office Use Only Verification with original documents : (Please put ( v ) where ever applicable) 1, MAT/ JEMATJECAIGATE/PGET OriginalAdmit Card - 2 Copies, 2, MATI JEMATIJECAIGATE/PGET Rand Card = 2 Copies 3, Admit Card - Class X (for DOB) = 2 Copies 4, Mark Sheet -Class X,, XII & Graduation - 2 Copies 5, College Leaving Certificate = 2 Copies 6. AADHAAR Card = 2 Copies. 7. PAN Card = 2.Copies 8, Three Copies of Coloured Pass Port Size Photograph Admission Fees Deposited Rs... (Rupees... Chalan No. ~ Signature of Dealing Assistant with date Signature of Dealing Officer Admitted Registrar

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