Registration Form
1. Admission to B.Tech : (Tick Mark the branch in which you wish to seek Admission)
Branch In B.Tech
1. Computer Science 4. Information Technology
2. Civil Engineering 5. Mechanical Engineering
3. Electronics & Communication
2.  Category                                              Gen.         SC:          ST:         OBC:          Other:   
3. Name of the Candidate (In capital Letters, as entered in HS/SSC Certificate):              
4. Father Name:
5. Mother Name: 6. Date of Birth :
7. Occupation: 8.Annual Income :
9. Permanent Address:
 Email Id(If Any): Telephone No:
10.Address of Local :  Telephone No:
11. Sex:   Male        Female 12. Nationality:
13. Is Hostel Accommodation required?:                Yes   No
Examination Year Board/Univ. Marks Obt. Max. Marks % Marks Division Remarks
15. Details of Pre-Engineering Entrance Exam Given:
S. No. Exam Roll Number Rank Marks
l. U.P.S.E.E.
2. A.I.E.E.E.
3. Other
16. State of Domicile:
17. Bank account details (PNB Only):
A/C Holder’s Name A/C No. Father’s Name with Address Nominee
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