Application

Application form
Please ( ) mark
B.Sc. B.C.A M.Sc. M.Tech
Affix recent
Biotechnology (Hons.) Microbiology Computer Sc.
passport size color
Food Technology E.I.S.
photograph of the
candidate
Instruction of Candidates:
1. Candidates are kindly advised to read the prospectus thoroughly.
2. Applications not complete in all respects would be summarily be rejected.
Application of the candidate does not automatically guarantee admission.
(TO BE FILLED IN BY THE APPLICANT)

1. Name of the Applicant (in block Letters, as per 10th standard certificate)
2. Name of the father
3. Name of the Guardian (in case father is not alive)

-2-
4. Occupation of father
5. Date of Birth 6. Gender

Male Female
e
7. Nationality 8. Religion
9. Correspondence Address 10. Caste GEN SC ST OBC
……………………………………………………………………………………………………
……………………………………………………………………………………………………
……………………………………………………………………………………………………
11. Permanent Address

……………………………………………………………………………………………………
……………………………………………………………………………………………………
……………………………………………………………………………………………………
12. Contact No.
13. Parents Contact No
14. E-mail ID
15. Blood Group 16. Do you need Hostel Accommodation: Yes No
17. Academic information from HSC of Equivalent

Exam Passed Name of the Subject/Discipline Year of % of
Board/University passing marks/
CGPA
High School
(10th standard)
10+2/or
Equivalent
B.Sc/or
Equivalent
B.Tech/or
Equivalent
M.Sc/or
Equivalent
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(For Hosteller)
1. Name of the Local Guardian
2. Address of the Local Guardian
3. Contact No -
4. Relationship of applicant with Local Guardian
5. Mention Chronic illness if any
Undertaking by the Hosteller

I hereby undertake to abide the rules and regulations of MITS hostel which understood by me,
if allotted a seat in the hostel provided by MITS, further I Undertake not to involve in
ragging/strike whatsoever which are illegal. During my stay at the hostel, and I will take the
foods provided by hostel..I would also be liable to make well any loss that may caused by me.
Place ……………………………
Date. …………………………… Signature of the Applicant
-4-
DECLARATION OF THE CANDIDATE
I hereby declare that all The Particulars stated by me in this Application are true to the best of
my knowledge and belief. I have read the Information Broucher for admission in to
MAJHIGHARIANI INSTITUTE OF TECHNOLOGY & SCIENCE (MITS), RAYAGADA
and I shall abide by the terms and condition therein. It is entirely my responsibility to prove
my eligibility for admission to the programme for which I am admitted and also, in respect of
qualification, nationality etc. made in my application form. I understand that my admission if
granted or degree acquired subsequently is liable for cancellation. I also understand that the
decision of MITS regarding my admission will be final and I shall abide by the ordinance and
regulations of MITS from time to time. It is my responsibility to abide the rules and
regulations framed by the concerned university of my current studies.
The Institute will not responsible if my admission will not be accepted by the University/State
Central authorities, I would also be liable to make good any loss that may caused due to
rejection of my admission on any ground. I am fully aware of the rules that the fees once paid
will neither be refunded nor adjusted under any circumstances whatsoever.
MODE FOR PAYMENT OF FEE:
The fees paid are non refundable and must be in shape of Demand Draft, in favour of
“MAJHIGHARIANI INSTITUTE OF TECHNOLOGY & SCIENCE” and payable at
RAYAGADA. Hostel fees once paid will not be refundable and the hostellers are required to
take food served at the hostel only.
Place. …………………………..
Date…………………………… Signature of the Applicant
DECLARATION OF THE PARENT / GUARDIAN
The facts mentioned above by my ward are true and above signature is of my ward. I hereby
declared that my ward will abide all the rules and regulations and also the codes of conduct of
the Institute and the University. I shall be totally responsible for his/her misconduct at the
institute if admitted and I promise to compensate for damage that may have been caused by
my ward during his/her tenure at the institute. The fees payment opted by me /my ward is
convenient to me and I will pay the dues whatsoever on or before the due dates.
Place. …………………………..
Date…………………………… Signature of the Parent/Guardian

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Application form

(TO BE FILLED IN BY THE APPLICANT)

2. Name of the father

3. Name of the Guardian (in case father is not alive)

5. Date of Birth 6. Gender

9. Correspondence Address 10. Caste GEN SC ST OBC

11. Permanent Address

12. Contact No.

13. Parents Contact No

15. Blood Group 16. Do you need Hostel Accommodation: Yes No

17. Academic information from HSC of Equivalent

2. Address of the Local Guardian

4. Relationship of applicant with Local Guardian

5. Mention Chronic illness if any

Undertaking by the Hosteller

DECLARATION OF THE CANDIDATE

MODE FOR PAYMENT OF FEE:

DECLARATION OF THE PARENT / GUARDIAN

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