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Engineering & Technology: Application Number

This document contains an application for admission to the engineering program at SRM University for the year 2016. It includes personal details of the applicant such as name, gender, date of birth, address, contact information, educational qualifications and choices for degree program and university campus. The applicant is seeking admission to the B.Tech program with specializations in computer science, electrical and electronics, or chemical engineering at the SRM University Chennai campus. The application mode is online and payment has been made.

Uploaded by

Mukesh Dixit
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
25 views

Engineering & Technology: Application Number

This document contains an application for admission to the engineering program at SRM University for the year 2016. It includes personal details of the applicant such as name, gender, date of birth, address, contact information, educational qualifications and choices for degree program and university campus. The applicant is seeking admission to the B.Tech program with specializations in computer science, electrical and electronics, or chemical engineering at the SRM University Chennai campus. The application mode is online and payment has been made.

Uploaded by

Mukesh Dixit
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 2

* 1720309 *

ENGINEERING & TECHNOLOGY

ADMISSION 2016

Application Number

9223723

2.SIGNATURE OF THE APPLICANT

3. NAME OF THE APPLICANT


MUDIT DIXIT
5.COMMUNITY

6. DATE OF BIRTH

Male

General/OC

12-Apr-1998

7.STATE

8.MOBILE NUMBER

Uttar Pradesh

8755497822

4. GENDER

YOUR COMPLETE POSTAL ADDRESS FOR COMMUNICATION

SRM UNIVERSITY

9. S/o, D/o, C/o

MUKESH KUMAR DIXIT

10. Address
M43
Ambica Avaas Colony Phase 1
Bareilly

11. CITY

Bareilly

12.DISTRICT

13.STATE

14.PINCODE

Bareilly

Uttar Pradesh

243122

15.STD CODE

16.TELEPHONE NUMBER
9837189024

17.EMAIL ADDRESS:

Application Printed Date:

RefID:

mudit.dixit2@gmail.com

Sat, 5 Dec 2015 10:57:50 +0530

Page 1 0f 2

18. PERCENTAGE OF MARKS (%) OBTAINED IN

X STANDARD: 93.10

19. DETAILS OF THE QUALIFYING EXAMINATION (XII STANDARD)

ADMISSION 2016

PASSED

APPEARING

APPEARING FOR IMPROVEMENT

SCHOOL EXAM

SCHOOL

BOARD/
UNIVERSITY

YEAR OF
PASSING

% OF MARKS

HSC/Equivalent

Woodrow Sr Sec
School

Central Board of
Secondary Education

2016

20. MODE OF ENTRANCE EXAM Online


21. Test City Preference 1

Bareilly 232

Test City Preference 2

Lucknow 237

Test City Preference 3

Roorkee 246

22. DEGREE APPLIED

B.Tech

23. CHOICE OF UNIVERSITIY AND COURSE/SPECIALIZATION


1. Computer Science and Engineering
2. Electrical and Electronics Engineering

SRM UNIVERSITY

SRM University Chennai(Four Campuses)

3. Chemical Engineering
4. Civil Engineering
5. Mechanical Engineering
1. 2. -

SRM University Haryana

3. 4. 5. -

25. SUBMISSION MODE: Online - Epay


26. ONLINE PAYMENT DATE: 30-11-2015 01:11 17 PM

TXN REF NO:

9223723S30112015015217460R188

27.DECLARATION
"I hereby declare that, I have carefully read all relevant instructions and understood the particulars supplied to me and that the entries made in this application form
are true and correct to the best of my knowledge and belief. I understand that the decision of the University is final with regard to selection for admission. If selected
for admission, I promise to abide by the rules and regulations of the University as existing and as would be amended from time to time. The University shall have the
right to expel me from the University at any time after admission, provided it is satisfied that I was admitted on false particulars furnished by me or my antecedents
proving that my continuance in the University is not desirable. Fees paid once will not be claimed back under any circumstances. I agree that all disputes are subject
to the jurisdiction of the courts at Chennai only".

VALID FOR THE ACADEMIC YEAR 2016-2017 ONLY


Application Printed Date: Sat, 5 Dec 2015 10:57:50 +0530

RefID:

Page 2 of 2

SIGNATURE OF APPLICANT

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