Online Application for Admission to M.Tech., M.Pharm. and Ph.D.

Programmes
for July 2015 Semester of Academic Session 2015-16
Application No . 15110496

1. Personal Information
Name: ABHISHIKT V V
Father's Name: PRABHAKAR V C
Mother's Name: NAGAMANI V
Date of Birth: 23/05/1992
Sex: M
Category: Gen.

Physically Challenged: No

Nationality: Indian

Email: abhishiktvenkata@gmail.com

Mobile No: 9494749731

Address for Correspondence:

Permanent Address:

C-10/5

C-10/5

D.A.E COLONY , E.C.I.L

D.A.E COLONY , E.C.I.L

HYDERABAD

HYDERABAD

TELANGANA - 500062

TELANGANA - 500062

3. Application processing fee

e-Receipt details:

e-Receipt No. DU16107436

Date: 04-MAY-2015

Amount Rs.: 500

4. Academic Information
4A. Details of Academic Record/Research Experience:
Exam Name

GATE/GPAT Discipline

GATE/GPAT
Roll Number

GATE/GPAT Score (OR)

CSIR/UGC-NET Rank

Year

GATE

CS

CS703409158

537

2014

Note: For M.Tech/M.Pharm Programmes, a valid GATE/GPAT score is required

4B. Qualifying degree already obtained or in progress

Institute/College
(Name and
Address)

SIDDHARTHA

University
(Name and
Address)

Discipline

Degree

Exam
Date

Final Results
declared/
Expected by

Pass Marks %
or Grade Point
Average

SIDDHARTHA
INSTITUTE OF
SCIENCE AND
TECHNOLOGY

JNTU
ANANTAPUR

COMPUTER
SCIENCE AND
ENGINEERING

B.TECH

06.04.2013

20.05.2013

70.8

Sem. I

Sem. II

Sem. III

Sem. IV

Sem. V

75.1

NA

73.2

64.4

64.5

Sem. VI

Sem. VII

Sem. VIII

Sem. IX

Sem. X

Overall % or
Grade Point
Average
(If degree
completed)

67.06

69.46

76

NA

NA

70.8

% Marks or
Grade Point
Average

4C. Other qualifications : High school onwards (Do not include the Degree listed in 4B)
Institute/College
(Name and
Address)

Name of the Examination

University
(Name and
Address)

Discipline

Degree

% Marks
or
Grade
Point

Date of
Completion

High School or equivalent Examination of

10th standard

BRILLIANT
GRAMMER HIGH
SCHOOL

STATE BOARD
OF
SECONDARY
NA
EDUCATION
ANDHRA
PRADESH

NA

77.6

2007

Intermediate or equivalent Examination of

10+2 level

BOARD OF
INTERMEDIATE
NARAYANA JUNIOR
EDUCATION
NA
COLLEGE
ANDHRA
PRADESH

NA

80.9

2009

Bachelor's degree/ Equivalent degree

NA

NA

NA

NA

NA

NA

Master's degree/ Equivalent degree

NA

NA

NA

NA

NA

NA

Any other degree

NA

NA

NA

NA

NA

NA

4D. Work Experience (only for Sponsored candidates)

Date
( from - to )

Employer

Position

Nature of Work

14.04.2014 14.07.2015

WIPRO TECHNOLOGIES

PROJECT
ENGINEER

ASSOCIATE CONSULTANT S.A.P

C.R.M

4E. Publications (if any)

Number of Technical Paper/books: (provide

Published in Journals nil

Published in Articles nil

details separately)
Published in Proceedings nil
Published in Books
nil
Details of Publications:

nil

4F. Referees' Details (Only for Ph D candidates):

Address of Referee 1

Address of Referee 2

NA

NA

NA

NA

NA

NA

E-mail ID:

NA

E-mail ID:

NA

5. Programme Selection
Student Status: Full-Time Regular

Financial Status: Scholarship Required

5A. Primary Programme you are applying for (Compulsory)

Programme:

M.Tech.

Department/School:

BM - School of Biomedical Engineering

6. Declaration by the Applicant

I declare that the information provided by me on this application form is correct to the best of my knowledge and belief. I understand that any wilful
misinterpretation of facts will result in my disqualification and dismissal from the Institute if admitted.

Date of Submission 04-05-2015 at 18:49:47 hrs.

Important note: Your application will be processed for calling you for written test/interview based on the information you have provided in this form. You
are advised to bring all the original certificates/mark sheets/grade sheets (Refer the checklists provided in the Instructions) in support of the claims made
by you in this application form, failing which, your application may be disqualified.

IIT(BHU),Varanasi-221005 (U.P.)