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Paste here firmly your

recent colour photograph
Application for Admission to B.Tech. Degree of good quality
Programmes (VITEEE-2011) (SIZE 3.5 X 4.5 CMS)
Applicant Signature

    Full Name : NANDU P Appln. No. : 2011408634

  Date of Birth : 24/08/1993 Gender : Male

  Nationality : Indian Religion : Hinduism

  Community : GENERAL / OC Native State : 23 - Kerala

    Address: Vazhayil, Murunthal Perinad PO Land Line : 04742704790
Kollam, Kerala, Mobile No. : 9895019553
, India - 691601 Email ID :
Parent Name : N Padmakumar Relationship : Father

  Qual. Exam:  12th Class or its Equivalent XII Board : 04 - Central Board of Secondary

  Reg.No./Roll No. : Mode of Study : Regular

  Month & Year of Passing : Mar - 2011 Hostel

: Yes

  Name & Address of

: Advertisement : The Hindu

Test City : 193

Beyond this point, the applicant has to fill in his / her own running handwriting

DD Details :
 DD amount of Rs.750/- for Indian Candidates and 50 USD for NRI Candidates drawn in favour of 'VIT University' payable at
VELLORE from _____________________________ Bank/Exchange, DD No. __________________,   dated

I solemnly and sincerely affirm that I am an Indian National and that all particulars furnished by me in this
application form are true and correct. I have not concealed any information. However, in the event of any
information being found to be incorrect, fraudulent or untrue, either before or after the examination or after my
admission to the programme, I understand that I am liable to face criminal prosecution and the management can
claim all authority to cancel my candidature / selection or admission as the case may be and I would have to forego
my seat and the fees.

I agree to abide by the rules and regulations governing the examination as well as the rules pertaining to the refund
of tuition and hostel fees contained in the brochure.

I further undertake to submit all the required certificates as per the rule, either at the time of interview or during the
admission process, failing which I understand that I would have to forego my seat and the fees.

Place: Signature of Parent / Guardian Signature of the Applicant
Keep the Xerox copy of the application after filling all the details for any future reference.

The filled-out application form to be sent along with the DD amount of Rs.750/- for Indian Candidates (or 50
USD for NRI Candidates) to the Admissions Officer, VIT University, Vellore-632 014, Tamil Nadu, India.

(Set the Paper Size as A4 from the Page Setup Menu option to print your application in A4 Paper Size)

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