5/21/2017 CFTRIM.Sc.

FOODTECHNOLOGYCOURSE201719

M.Sc.(FOODTECHNOLOGY)COURSE201719:APPLICATIONFORM

(AllFieldsareMandatory)Rs.300/forSC/STCandidatesandothersRs.600/NonTransferable&NonRefundable

PERSONALDETAILS

Name(FullandinBLOCKlettersasinXMarksCard) DABURSINGH

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UploadYourrecentPhotograph (PhotoDimension:150(W)x200(H)FileSize:<100KB)
MailingAddress(InBLOCKLetters)

AddressLine1: ANANDBASTI

AddressLine2:

AddressLine3:

City Pincode
AddressLine4:
PATRAN 147105

State Country
AddressLine5:
Punjab

STDCode Number
ResidenceNumber:

MobileNumber: +91 9876543210

Email: XYZ2@sharklasers.com

Gender: Male Female Transgender

Nationality: indian

DateofBirth: 19051996

UR
Category:
[Note:AsperGovernmentofIndiaRulesandRegulations]

DoyouhaveanyPhysicalDisabilities(Y/N):
Yes No
[IfYes,attachattestedcopyofcertificateissuedfromtheCompetentAuthority]

DetailsofPayment(NEFT/RTGSDetails):
UTRNo.:

Amount:

DateofPayment:

IFSCCode:

NameoftheBank:

Preference:01 Preference:02
Mysuru Mysuru
PlaceofOnlineEntranceExamination Bengaluru Bengaluru
(SelectanyTwopreferableCentresonly) Chennai Chennai
Delhi Delhi
Mumbai Mumbai

ParticularsofParent/Guardian:
FathersName: Shri Ashinghi
Ifemployed,detailsofemploymentalongwithcontactaddress:

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FathersMobileNumber: +91 7846212365

AnnualIncome(Rs.)ofFather[ITReturn/IncomeProof
compulsory]: Rs. 100000 (Enteronlynumbers)

MothersName: Smt. Bsinghi

Ifemployed,detailsofemploymentalongwithcontactaddress
number:

MothersMobileNumber: +91
AnnualIncome(Rs.)ofMother[ITReturn/IncomeProof
compulsory]: Rs. 0 (Enteronlynumbers)

NameoftheGuardian:

RelationshipofGuardian:

Ifemployed,detailsofemploymentalongwithcontactaddress
number:

GaurdiansMobileNumber: +91
AnnualIncome(Rs.)ofGuardian[ITReturn/IncomeProof
compulsory]: Rs. (Enteronlynumbers)

EDUCATIONDETAILS

Yearof
ExamPassed NameofSchool/College Board/University Percentage Grade
Passing

SSLC/SSCorEquivalent SAIS CBSE 2012 74 A

HigherSec./PreUniversity SAIS cbse 2014 84 A

Degree(Graduate) sais cbse 2017 84 A

Anyother(Specify)

NOTE:Enclose self attested copies in support of marks / grade obtained in all examinations (for all years / semesters of
thecourse)listedabove.

QUALIFYINGEXAMDETAILS

NameofthequalifyingExam: BACHELOROFVOCATIONALFOODPROCESSINGANDENGINEERING

Durationofcourse: 6Semesters

Semester/Year CGPA/MarksObtained Scale/TotalMarks

1stSemster
2ndSemster
3rdSemster
4thSemster
5thSemster
6thSemster

YearofPassing: 2017

PercentageofMarks: Percent CGPA Outof

(AggregateofallSemesters/
Years)

Marksobtainedinwords:

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5/21/2017 CFTRIM.Sc.FOODTECHNOLOGYCOURSE201719
CGPAConvertedtopercentage: %
ProvideFormulaforcalculation
ofpercentage
incaseofgradedeclaration:

*Uptowhichsemester/year,
Year Semester
incasefinalsem/yearmarks
areawaited(Iffinalsemester/ 20
YearthenwriteFinal):

NameofCollege/Institution:

NameofUniversity:

Markscarduptowhich
Semester/Year:

NOTE : If the final marks sheet / grade cards are not available at the time of submitting the application, it may be
communicated to us immediately in the above format mentioning ALL details and quoting the UNIQUE REGISTRATION
NUMBER. However, marks sheet/ grade cards RECEIVED AFTER LAST DATE FOR SUBMISSION WILL NOT BE
CONSIDEREDANDAPPLICATIONWILLBEREJECTED

SUBMIT

2010.CentralFoodTechnologicalResearchInstitute(CFTRI).AllRightsReserved.
Developed&MaintainedbyDepartmentofComputerCentre,CFTRI

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