Beruflich Dokumente
Kultur Dokumente
_______________
(Not to be filled in by the candidate)
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Telephone:____________ Fax:_____________E-mail:______________________
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* As in qualifying examination
** As in Matriculation Certificate
* Merit No. ……………… * Institute Roll No….. ………………..
DEPARTMENT**
SPECIALISATION (IN ORDER OF PREFERENCE)
Exam. Year Roll No. Div. Marks %age Name of Institute &
Passed Obtained Marks University
(with discipline)
BE/B.Sc.
(Engg.)/
B.Tech.( )
M.Sc. ( )
Institute …………………………………………………………………………….
Year …………………………… Discipline ………………………………………
Roll No. ………………………..Amount of Scholarship drawn ………………….
13. Have you ever been disqualified or debarred from appearing in any examination conducted by a
University/ Board? Yes / No
If yes, give particulars:………………………………..
It is declared that all the entries made in this form are correct. I further declare that I fulfill the
minimum eligibility conditions laid down for admission. In case of detection of any false entry,
especially in respect of degree examination/experience/sponsoring certificate, my admission may be
treated as cancelled any time during the course of my study and I will have no claim what-so-ever.
LIST OF ENCLOSURES
NO OBJECTION CERTIFICATE
For Non- sponsored but in service candidates