Registration

Course Applied For:      B.Tech

Choice-I     CSE IT ECE EI EN ME CIVIL   Choice-II CSE IT ECE EI EN ME CIVIL Choice-III   CSE IT ECE EI EN ME CIVIL

SEE-UPTU Appeared Yes  No SEE-UPTU Roll No SEE-UPTU Rank XII PCM % ( 2 decimal) XII PCB % ( 2 decimal) AIEEE Appeared Yes  No AIEEE Roll No. AIEEE Rank(All India) CAT/MAT Score(MBA Only)

CANDIDATE PERSONAL DETAILS Name (in block letters) Father's Name Mother's Name Occupation Date of Birth Date 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month 1 2 3 4 5 6 7 8 9 10 11 12 Year 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 Category GEN SC ST OBC              Gender   Male Female

EDUCATIONAL QUALIFICATION Examination Board/University School/College 10th/High School 12th/Intermediate       Passing Year % of Marks Subjects Graduation NONE B.Tech B.Sc BBA BCA BA B.Com M.Sc B.Pharma Address: Pin Code: Phone No (STD Code) Mobile No: E-Mail: