Admission Form

For office use

only

Sr.No. Branch Allotted…………………

Shri Krishan Institute of Engineering and Technology Kurukshetra (Approved by A.I.C.TE & DTE & Affiliated to Kurukshetra University, Kurukshetra)

Application Form for Admission in B.Tech 4 years Degree course 1.

(To be filled by Candidates’ own handwriting) Name in full ………………………………….

2.

Father’s Name

…………………………………

3.

Mother’s Name

………………………………….

4.

Date of Birth

………………………………….

5.

Nationality

………………………………….

6.

Religion

………………………………….

7.

Address (Correspondence)

…………………………………………………….. …………………………………………………… .. …………………………………………………….. ……………………………………………………… …………………………………………………....... ……………………………………

Address(Permanent) 8.

AIEEE/LEET Rank

Branch options

9.

Category

……………………………………

10.

General/SC/ST/BC/OBC

……………………………………

11.

Details of qualifying Examination:

1. ………………. 2……………….. 3………………. . 4………………..

(i) Name of Exam …………………………………………………….. (ii) Institution Name …………………………………………………….. City/State/UT …………………………………………………… (iii) Details of Marks obtained in qualifying Exam.:Subject

Total:

Max.Marks Marks obtained

Uni./Board

Year of Passing

Roll No.

%age of marks

(iv)

Passed in first attempt

: Yes/No

12.

Ever disqualified from studies : Yes/No If year, give details……………………………………………………………………

13.

Demand Draft for Rs.250/- enclosed

14.

Declaration: Certified that all the entries made in this form are correct to the best of my knowledge and

Yes/No

DD No……………..

belief. Place: Date:

Signature of Candidate

UNDERTAKING 1. I, hereby, opt and accept my admission to B.Tech …………. Degree course in the discipline of ……………………….. Shri Krishan Institute of Engineering and Technology, Kurukshetra, consequent upon my ranking/position…………………. in LEET/AIEEE2009. I hereby further affirm, declare and undertake that I shall abide by the rules & regulations of the Institution & its affiliated university. 2. I clearly understand that my admission is PROVISIONAL and is subject to the rules and regulations of this college and its affiliated university. 3. I understand that admission is being offered to me on the basis of the information furnished by me. In case any information/particulars are found false/wrong, my admission shall stand cancelled and I shall have no claim whatsoever in respect of my admission and fees etc. deposited 4. I have accepted the admission at my own risk & responsibility subject to the confirmation of my admission by the concerned university. If at any stage, I am declared or found ineligible under the rules, I shall have no claim for it any my admission shall stand automatically cancelled and ab-initio, in consequence thereof. 5. I also further agree- that the institute shall not be liable in any manner for any consequential effect financial or otherwise, for any illegality/irregularity by the admission Authority at the time of my admission. 6. I have gone through all the rules & regulations given in college prospectus and undertake to abide by the same.

Signature of the Parent/Guardian Signature of the Candidate _________________________________________________________________________ For office use: Admitted/Not Admitted

Remarks, if any………………………………………

Signature of the Convener