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Adm Form For Iit 2012

This document is an application form for admission to the Indian Institutes of Technology (IITs) for the year 2012. It requests information such as the applicant's name, date of birth, gender, nationality, category, academic qualifications, address, and a declaration that the information provided is true. The applicant must provide their photograph, signature, and left thumb impression. There is also an undertaking for applicants whose qualifying exam results are still awaited, stating that their admission is provisional until original certificates are submitted.

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Nishant Groha
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67 views2 pages

Adm Form For Iit 2012

This document is an application form for admission to the Indian Institutes of Technology (IITs) for the year 2012. It requests information such as the applicant's name, date of birth, gender, nationality, category, academic qualifications, address, and a declaration that the information provided is true. The applicant must provide their photograph, signature, and left thumb impression. There is also an undertaking for applicants whose qualifying exam results are still awaited, stating that their admission is provisional until original certificates are submitted.

Uploaded by

Nishant Groha
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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IIT-JEE 2012 APPLICATION FORM FOR ADMISSION INDIAN INSTITUTES OF TECHNOLOGY

Bhubaneswar, Bombay, Delhi, Gandhinagar, Guwahati, Hyderabad, Indore, Kanpur, Kharagpur, Madras, Mandi, Patna, Rajasthan, Roorkee, Ropar, IT-BHU Varanasi and ISM Dhanbad 1. IIT-JEE 2012 Registration No. 3. IIT-JEE 2012 Application No. 4. Nationality (Indian/Foreign) 5. Category (Tick whichever is applicable) GE OBC(NCL) OBC(NCL)-Minority SC ST PD DS 6. Applicants Name 7. Date of birth (DD/MM/YYYY):... 8. Sex:. 2. a) All India Rank b) Category Rank Paste your recent photograph here

9. Parents/Guardians Name. 10. Permanent Address Pin Code... Mobile No.. 12. Academic Qualifications Examination 10th Class 10+2 Class/Intermediate Any other Public Examination 13. Are you colour blind or uniocular? 14. Declaration: I hereby declare that the particulars stated above are true to the best of my knowledge and belief. In the event of suppression or distortion of any fact, I understand that my admission/degree acquired is liable to cancellation. I also understand that the decision of the Joint Admission Board regarding my admission to any of the IITs/IT-BHU Varanasi/ISM Dhanbad is final and I shall abide by the rules and norms of the discipline of the Institute which I join. Yes/No School/College Board/University Year of Passing Percentage of marks 11. Address for Communication . . . Pin Code.... Email id...

Left thumb impression of the Candidate......... Signature of the Candidate Place:.............. Date:................ Countersigned by Parent/Guardian

IIT-JEE 2012 INDIAN INSTITUTES OF TECHNOLOGY


Bhubaneswar, Bombay, Delhi, Gandhinagar, Guwahati, Hyderabad, Indore, Kanpur, Kharagpur, Madras, Mandi, Patna,Rajasthan, Roorkee, Ropar, IT-BHU Varanasi and ISM Dhanbad

UNDERTAKING

(to be given by a candidate whose qualifying examination result is awaited and hence provisionally admitted)
1. 2. 3. 4. Name. IIT-JEE 2012 Registration No.. All India Rank:. Category: [GE/OBC (NCL)/OBC(NCL)-Minority/SC/ST] ... .PD: YES/NO DS: YES/NO

I understand that my admission to any of the IITs/IT-BHU, Varanasi/ISM Dhanbad is provisional since I have not submitted the original and two attested copies of the Qualifying Examination certificate and/or mark sheet as per the eligibililty criteria stated in Section III of the Information Brochure for IIT-JEE 2012. I will produce the original certificate of the qualifying examination at the time of Registration or on or before September 30, 2012 to the respective Institutes.

. Left Thumb impression of the candidate

.. Signature of the candidate

Place:.. Date:..

Countersigned by Parent/Guardian

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