Application for admission into the M.
Tech Course under category B seats
for the academic year 2013-14
Name of the branch in which admission is sought:______________________________________________
Date of payment
Amount in Rs
Cash Receipt No. /DD No.
Name of the Bank
Name of the Applicant _____________________________________________________________
(In block letters as per SSC)
Fathers Name _____________________________________________________________
Date of Birth (dd-mm-yyyy) _______________________ Category OC / SC / ST / BC (A /B /C /D /E)
(As per SSC)
GATE / PGECET -2013 Rank ______________ H.T.No. ___________________ Gender: Male / Female
Nationality __________________Religion____________ State ___________________
Address for Correspondence _____________________________________________________________
(with Pin Code)
_____________________________________________________________
Mandal /Town _________________________________Dist_________________________
State _________________________________ Pin code_____________________
Telephone (with STD code) ___________________________ Cell phone _________________________
Email Address _____________________________________________________________
Examination Year of
Passing
Institution Attended Board/ Univ. Marks
Obtained
% of
Marks
Class/
Grade
SSC / CBSE
Inter/10+2
Degree
DECLARATION
We declare that all the particulars given above are true to the best of our knowledge. We understand that any
particulars given in the application, if found incorrect on scrutiny, will render the application liable to be rejected
and admission granted on the basis of such incorrect information will stand cancelled.
_______________________ ________________________________
(Signature of the Applicant) (Signature of the Father/Mother/Guardian)
________________________ _______________________
(Name in block letters) (Name in block letters)
Affix Latest Passport
size photo
SWAMI RAMANANDA TIRTHA INSTITUTE OF SCIENCE AND TECHNOLOGY
Ramananda Nagar, Post: S.L.B.C., Nalgonda 508 004.
Approved by AICTE, New Delhi, Affiliated to J.N.T. University, Hyderabad
Ph:- 08682 221610 Fax:- 08682-221637 Mobile:9642471444
E-Mail:
[email protected] Website: www.srtist.ac.in