1. Enter your name *

2. Enter your parent/guardian name

3(a). Enter your address of communication *

3(b). Pincode*

4(a). Phone Number

4(b). Mobile Number *

4(c). Email ID*

5. Date of birth*

6. Gender

MaleFemaleTransgender

7. Religion

8. Mother Tongue

9. Nationality

IndianOther

10. Choice of branches in the order of preference *

(a): Select BranchBE – Civil EngineeringBE – Mechanical EngineeringBE – Electrical & Electronics EngineeringBE – Electronic & Communication EngineeringBE – Computer Science EngineeringB.Tech – Information Technology

(b): Select BranchBE – Civil EngineeringBE – Mechanical EngineeringBE – Electrical & Electronics EngineeringBE – Electronic & Communication EngineeringBE – Computer Science EngineeringB.Tech – Information Technology

11. Board of Examination*

State BoardCBSEOthers

12. Medium of study

13. Name of the school

14. 12th Registration Number *

15. Month & Year of passing *

16. Marks

#(a) Marks in Maths to 50 (b) marks in Physics & Chemistry reduce 50 (c) Cut of Marks: (a)+(b)

17. Parents Details

18. List the outstanding sports/cultural achievements, scholarships received, prizes/honors won etc.

19. Height (cms)

20. Weight (kgs)

21. Blood Group

22. Aadhar Card No

23. Attachments

(i). Copy of Transfer Certificate :

(ii). Copy of 10th Marksheet :

(iii). Copy of 12th Marksheet :

(iv). Copy of Community Certificate :

(v). Passportsize Photograph :

Station

Date

I declare that the information furnished in above is true and correct to the best of my knowldge.