ANNEXURE IV: APPLICATION FORM (A) FOR ADMISSION TO GCET BASED

PROFESSIONAL DEGREE COURSES 2018-19 (ENGINEERING & PHARMACY)

FORM A
APPLICATION FOR ADMISSION TO PROFESSIONAL DEGREE COURSES 2018-19
FOR GCET-2018 BASED COURSES (ENGINEERING and PHARMACY)ONLY

Following nos. will be entered at the ADMISSION CENTRE at the time of Form submission
FORM A
GCET NO.
REG. NO.
FORM B FORM C
REG. NO. REG. NO. Affix photograph
(Copies of the same photo to be
INSTRUCTIONS TO CANDIDATES: affixed on all Forms & the
1. Read rules of admission and eligibility criterion as given in the prospectus before filling the form. Acknowledgment Card)
2. Applicant must fill the form in his/her own handwriting, after downloading & printing the same from the website, or obtaining it from the
Application Receiving Centre. Submit the form at the Application Receiving Centres on specified dates along with self attested copies of
required documents.
3. Kindly note that this form is for applying only to GCET-2018 based courses and DOES NOT INCLUDE courses: MBBS, BDS, BHMS, BAMS,
BSc NURSING, AHS and B.ARCH., for which different forms are specified.

1. CATEGORY APPLIED FOR [Encircle the appropriate box (es)]

1 2 3 4 5 6 7 8 9 10 11 12 13 14
GN NRI* FN/
GEN SC ST OBC PH FF CSP ESM LA ST OBC GO NGO
OGA KM PIO/
GULF
*NRI Category applicants may indicate if they are of Goan Origin(GO),Not Goan Origin(NGO)
2. NAME OF THE CANDIDATE: [In Block letters as recorded in the HSSC/SSC mark sheet]

3. GENDER: MALE FEMALE

4. CONTACT NOS:
(Tick the appropriate box)
5. AADHAAR CARD NO: 6. DATE OF BIRTH:

7. H.S.S.C. (Std. XII Sc.) or Equivalent Examination: (Details & Marks)

Board: Month: Year: Seat No.:
ENGLISH PHYSICS CHEMISTRY MATHS BIOLOGY OTHERS AGGREGATE
MAX MARKS MAX MARKS MAX MARKS MAX MARKS MAX MARKS MAX MARKS MAX MARKS

8. GCET - 2018 MARKS FOR OFFICE USE ONLY

GCET SCORES GCET ROLL
H.S.S.C.E SCORES
PHYSICS CHEMISTRY MATHEMATICS
P C M P C NO. M CS/BT/IP PM + X PC + X

ADMISSION STATUS: DOA DOC

PLEASE TURN OVER

9. DECLARATION OF APPLICANT

Certified that I, ___________________________________________am an Indian National/OCI, and have read and accepted the
provisions of the Prospectus, and have enclosed the self-attested copies of all the certificates in proper order as
required, and submitted the application complete in all respects. In the event of my application found to be deficient
or incomplete, and rejected by Admitting Authority, I shall be held responsible for the same.
I, _____________________________________________ hereby declare that the particulars furnished above are true, complete, and
correct to the best of my knowledge and belief. I am fully aware that in the event of any information being found false
or incorrect, or ineligible, being detected before or after the admission, appropriate action as deemed fit, by the
Competent Authority, can be taken against me.

PLACE: _____________________ _________________________

(Signature of the Applicant)
DATE: ______________________
___________________________________
ADDRESS : ______________________________________ Name as signed (Write in Capital letters)
_________________________________________________
MOBILE: ____________________________
ADDITIONAL MOBILE NO. / LANDLINE NO.: ____________________________________

10. DECLARATION BY PARENT/GUARDIAN OF THE APPLICANT

I, Shri/Smt. _______________________________________________ aged ________ years,
father/mother/guardian of Mr./Miss.
_________________________________________________________________, resident of Village/Town
_____________________________________, District ____________________, in the State of
_______________________ hereby declare that I have read and accepted the provisions of the Prospectus and
the Particulars furnished in the application, including total annual income of both parents, are correct to the
best of my knowledge and belief. I declare that I shall be held responsible for timely payment of all fees, rent,
and other charges in respect of my son/daughter/ward during the period of his/her studies in the College.
I hereby declare that the Institute will not in any way be held responsible for accidents/injuries caused to my
ward during the Classes, Practicals, Inplant Training in Industries, Educational Tours, Sports activity etc.
DATE: _____________

___________________________________ ___________________________________
(Signature of the Parent/Guardian) Name as signed (Write in Capital letters)
11. CHECK LIST FOR THE DOCUMENTS TO BE ATTACHED
1. Please attach self- attested xerox copies of the certificates in following order and tick appropriately.
2. No original document should be attached, as the admission committee shall not be responsible for loss of original
document.
3. Application form is to be submitted by the notified date, as specified in the prospectus.
Sr. No. Documents to be submitted Attached Checked
1. Photograph on the form
2. Statement of marks/Certificate/provisional certificate of passing HSSC
3. Certificate in support of residence
4. Documents for relaxation in the period of residence, if any
5. Certificate for reserved category claimed
6. Certificate of date of birth
7. School/college leaving certificate
8. Eligibility Certificate from Goa University (for applicants other than Goa Board)
9. Income Certificate (for fee concession)
10. Copy of Aadhaar Card
11. Acknowledgement card with photograph
12. Candidate Copy of GCET Admit Card
ADDITIONAL DOCUMENTS

FOR OFFICE USE ONLY

Checked by:
Categories accepted:
 ANNEXURE V :APPLICATION FORM(C) FOR ADMISSION TO B.ARCH DEGREE COURSE 2018-19.
FORM C(FOR ARCHITECTURE)
FORM C
APPLICATION FOR ADMISSION TO PROFESSIONAL DEGREE COURSES 2018-19
(FOR ARCHITECHTURE ONLY)

Following nos. will be entered at the ADMISSION CENTRE at the time of Form submission
FORM C NATA
REG. NO. REG NO.
FORM A FORM B
REG. NO. REG. NO.
INSTRUCTIONS TO CANDIDATES: Affix photograph
1. Read rules of admission and eligibility criterion as given in the prospectus before filling the form. (Copies of the same photo to be
2. Applicant must fill the form in his/her own handwriting, after downloading & printing the same from the website, or obtaining it from the affixed on all Forms & The
Application Receiving Centre. Submit the form at the Application Receiving Centres on specified dates along with self attested copies of Acknowledgment Card)
required documents.
3. Applicants who have not submitted GCET-2018 applications earlier, need to remit an application fee of Rs. 1500/- payable vide Demand
Draft, at Panaji drawn on any Scheduled Bank, in the name of ‘Director of Technical Education’ or any other approved mode of remittance,
as may be duly notified.
4. Kindly note this form is for applying only to B.ARCH. course and DOES NOT INCLUDE courses: MBBS, BDS, BHMS, BAMS, BSc
NURSING, AHS, ENGINEERING and PHARMACY, for which different forms are specified.
Whether applied for MBBS / BDS/ ENGINEERING/PHARMACY/ BHMS/ BAMS/ AHS/ NURSING:

YES NO
1. CATEGORY APPLIED FOR [Encircle the appropriate box (es)
1 2 3 4 5 6 7 8 9 10 11
GEN SC ST OBC PH FF CSP ESM LA GN OGA
2. NAME OF THE CANDIDATE: [In Block letters as recorded in the HSSC/SSC mark sheet]

3. GENDER: MALE FEMALE

4. CONTACT NOS:
(Tick the appropriate box)

5. AADHAAR CARD NO: 6. DATE OF BIRTH:

7. H.S.S.C. (Std. XII Sc.) or Equivalent Examination: (Details & Marks)

Board: Month: Year: Seat No.:
MATHS AGGREGATE
MAX MARKS MAX MARKS

8. DIPLOMA Scores: 9. NATA Scores:

NATA
EXAM SEAT NO:
ROLL NO:
MATHS MARKS AT DIPLOMA TOTAL MARKS AT DIPLOMA NATA SCORE
MAX MARKS MAX MARKS

(BANK NAME)
10. GCET ROLL NO. 11. DEMAND DRAFT NO:

FOR OFFICE USE ONLY

NATA SCORE H.S.S.C.E / DIPLOMA SCORES
MATHS MARKS AGG – (SM)

ADMISSION STATUS: DOA DOC

PLEASE TURN OVER

9. DECLARATION OF APPLICANT

Certified that I, ___________________________________________am an Indian National/OCI, and have read and accepted the
provisions of the Prospectus, and have enclosed the self-attested copies of all the certificates in proper order as
required, and submitted the application complete in all respects. In the event of my application found to be deficient
or incomplete, and rejected by Admitting Authority, I shall be held responsible for the same.
I, _____________________________________________ hereby declare that the particulars furnished above are true, complete, and
correct to the best of my knowledge and belief. I am fully aware that in the event of any information being found false
or incorrect, or ineligible, being detected before or after the admission, appropriate action as deemed fit, by the
Competent Authority, can be taken against me.

PLACE: _____________________
_________________________
(Signature of the Applicant)
DATE: ______________________
___________________________________
ADDRESS : ______________________________________ Name as signed (Write in
Capital letters)
_________________________________________________
MOBILE: ____________________________
ADDITIONAL MOBILE NO. / LANDLINE NO.: ____________________________________
10. DECLARATION BY PARENT/GUARDIAN OF THE APPLICANT
I, Shri/Smt. _______________________________________________ aged ________ years,
father/mother/guardian of Mr./Miss.
_________________________________________________________________, resident of Village/Town
_____________________________________, District ____________________, in the State of
_______________________ hereby declare that I have read and accepted the provisions of the Prospectus and
the Particulars furnished in the application, including total annual income of both parents, are correct to the
best of my knowledge and belief. I declare that I shall be held responsible for timely payment of all fees, rent,
and other charges in respect of my son/daughter/ward during the period of his/her studies in the College.
I hereby declare that the Institute will not in any way be held responsible for accidents/injuries caused to my
ward during the Classes, Practicals, Inplant Training in Industries, Educational Tours, Sports activity etc.
DATE: _____________

_______________________________ ___________________________________
(Signature of the Parent/Guardian) Name as signed (Write in Capital letters)
11. CHECK LIST FOR THE DOCUMENTS TO BE ATTACHED
1. Please attach self- attested xerox copies of the certificates in following order and tick appropriately.
2. No original document should be attached, as the admission committee shall not be responsible for loss of original
document.
3. Application form is to be submitted by the notified date, as specified in the prospectus.
Sr. No. Documents to be submitted Attached Checked
1. Photograph on the form
2. Statement of marks/Certificate/provisional certificate of passing HSSC
3. Certificate in support of residence
4. Documents for relaxation in the period of residence, if any
5. Certificate for reserved category claimed
6. Certificate of date of birth
7. School/college leaving certificate
8. Eligibility Certificate from Goa University (for applicants other than Goa Board)
9. Income Certificate (for fee concession)
10. Copy of Aadhaar Card
11. Acknowledgement card with photograph
12. Candidate Copy of GCET Admit Card
13. NATA Score Card
ADDITIONAL DOCUMENTS

FOR OFFICE USE ONLY

Categories accepted: Checked by:
 ANNEXURE VI: APPLICATION FORM (B) FOR ADMISSION TO PROFESSIONAL
DEGREE COURSES 2018-19 FOR NEET-2018 BASED COURSES (ONLY FOR MBBS, BDS,
BHMS, BAMS, AHS &NURSING)
FORM B
APPLICATION FOR ADMISSION TO PROFESSIONAL DEGREE COURSES 2018-19
FOR NEET-2018 BASED COURSES (MBBS, BDS, BHMS, BAMS, BSc NURSING and AHS)ONLY

Following nos. will be entered at the ADMISSION CENTRE at the time of Form submission
FORM B
NEET NO.
REG. NO.
FORM A FORM C
REG. NO. REG. NO.
INSTRUCTIONS TO CANDIDATES: Affix photograph
1. Read rules of admission and eligibility criterion as given in the prospectus before filling the form. (Copies of the same photo to be
2. Applicant must fill the form in his/her own handwriting, after downloading & printing the same from the website, or obtaining it from the affixed on all Forms & the
Application Receiving Centre. Submit the form at the Application Receiving Centres on specified dates along with self attested copies of Acknowledgment Card)
required documents.
3. Applicants who have not submitted GCET-2018 application earlier, need to remit an application fee of Rs. 1500/- payable vide Demand
Draft, at Panaji drawn on any Scheduled Bank, in the name of ‘Director of Technical Education’ or any other approved mode of remittance,
as may be duly notified.
4. Kindly note that this form is for applying to admissions to NEET-2018 based courses and DOES NOT INCLUDE courses: ENGINEERING,
PHARMACY and B.ARCH., for which different forms are specified.

1. CATEGORY APPLIED FOR [Encircle the appropriate box (es)]

1 2 3 4 5 6 7 8 9 10 11 12
GEN SC ST OBC PH FF CSP ESM LA GN NRI* OGA
GO NGO
*NRI Category applicants may indicate if they are of Goan Origin(GO),Not Goan Origin(NGO)
2. NAME OF THE CANDIDATE: [In Block letters as recorded in the HSSC/SSC mark sheet]

3. GENDER: MALE FEMALE

4. CONTACT NOS:
(Tick the appropriate box)

5. AADHAAR CARD NO: 6. DATE OF BIRTH:

7. H.S.S.C. (Std. XII Sc.) or Equivalent Examination: (Details & Marks)

Board: Month: Year: Seat No.:
ENGLISH PHYSICS CHEMISTRY MATHS BIOLOGY OTHERS AGGREGATE
MAX MARKS MAX MARKS MAX MARKS MAX MARKS MAX MARKS MAX MARKS MAX MARKS

8. NEET SEAT NO:

NEET-2018 ALL INDIA RANK: NEET-2018 PERCENTILE SCORE:
PLEASE TURN OVER

(BANK NAME)
9. GCET NO ( If Applicable): DEMAND DRAFT NO.

FOR OFFICE USE ONLY

GCET SCORES H.S.S.C.E SCORES
P C M P C B PCB AGG

ADMISSION STATUS: DOA DOC

9. DECLARATION OF APPLICANT

Certified that I, ___________________________________________am an Indian National/OCI, and have read and accepted the
provisions of the Prospectus, and have enclosed the self-attested copies of all the certificates in proper order as
required, and submitted the application complete in all respects. In the event of my application found to be deficient
or incomplete, and rejected by Admitting Authority, I shall be held responsible for the same.
I, _____________________________________________ hereby declare that the particulars furnished above are true, complete, and
correct to the best of my knowledge and belief. I am fully aware that in the event of any information being found false
or incorrect, or ineligible, being detected before or after the admission, appropriate action as deemed fit, by the
Competent Authority, can be taken against me.

PLACE: _____________________ _________________________

(Signature of the Applicant)
DATE: ______________________
___________________________________
ADDRESS : ______________________________________ Name as signed (Write in Capital letters)
_________________________________________________
MOBILE: ____________________________
ADDITIONAL MOBILE NO. / LANDLINE NO.: ____________________________________

10. DECLARATION BY PARENT/GUARDIAN OF THE APPLICANT

I, Shri/Smt. _______________________________________________ aged ________ years,
father/mother/guardian of Mr./Miss.
_________________________________________________________________, resident of Village/Town
_____________________________________, District ____________________, in the State of
_______________________ hereby declare that I have read and accepted the provisions of the Prospectus and
the Particulars furnished in the application, including total annual income of both parents, are correct to the
best of my knowledge and belief. I declare that I shall be held responsible for timely payment of all fees, rent,
and other charges in respect of my son/daughter/ward during the period of his/her studies in the College.
I hereby declare that the Institute will not in any way be held responsible for accidents/injuries caused to my
ward during the Classes, Practicals, Inplant Training in Industries, Educational Tours, Sports activity etc.
DATE: _____________

_______________________________ ___________________________________
(Signature of the Parent/Guardian) Name as signed (Write in Capital letters)
11. CHECK LIST FOR THE DOCUMENTS TO BE ATTACHED
1. Please attach self- attested xerox copies of the certificates in following order and tick appropriately.
2. No original document should be attached, as the admission committee shall not be responsible for loss of original
document.
3. Application form is to be submitted by the notified date, as specified in the prospectus.
Sr. No. Documents to be submitted Attached Checked
1. Photograph on the form
2. Statement of marks/Certificate/provisional certificate of passing HSSC
3. Copy of NEET UG -2018 result
4. Certificate in support of residence
5. Documents for relaxation in the period of residence, if any
6. Certificate for reserved category claimed
7. Certificate of date of birth
8. School/college leaving certificate
9. Eligibility Certificate from Goa University (for applicants other than Goa Board)
10. Income Certificate (for fee concession)
11. Copy of Aadhaar Card
12. Acknowledgement card with photograph
13. Candidate Copy of GCET Admit Card
14. Copy of NEET Examination Admit Card
ADDITIONAL DOCUMENTS

FOR OFFICE USE ONLY

Categories accepted: Checked by:
 GOVERNMENT OF GOA
DIRECTORATE OF TECHNICAL EDUCATION
DEGREE COURSES ADMISSION-2018
ACKNOWLEDGEMENT CUM ADMISSION CARD
(THIS CARD MUST BE PRODUCED AT THE TIME OF SUBMISSION OF APPLICATION FORM A,B,C)
FORM A REG.NO. FORM C REG.NO. FORM B REG.NO.
(ENGINEERING/PHARMACY) (ARCH.) (MBBS , BDS, BHMS,
BAMS/AHS/NURSING)

NAME
PHOTO
CATEGORIES
MBBS/BDS B.E B. PHARM. B.ARCH
ELIGIBILITY BHMS/BAMS /AHS/
NURSING
ORDER OF MERIT
CONCESSION NIL 30% 50%
DETAILS OF ADMISSION (FOR B.E., B. PHARM)
Acknowledgement of
Admission Round Date Course Institute Sign. of Authority
Institute.
FIRST

SECOND

THIRD

EXTRA
(if applicable)

DETAILS OF ADMISSION (FOR MBBS , BDS, BHMS, BAMS, AHS &NURSING)

Acknowledgement of
Admission Round Date Course Institute Sign. of Authority
Institute.
FIRST

SECOND

THIRD
 DETAILS OF ADMISSION (FOR MBBS, BDS, BHMS, BAMS, AHS & NURSING)
Acknowledgement of
Admission Round Date Course Institute Sign. of Authority
Institute.
EXTRA
(if applicable)

DETAILS OF ADMISSION (FOR B.ARCH.)

Acknowledgement of
Admission Round Date Course Institute Sign. of Authority
Institute

FIRST

SECOND

EXTRA
(if applicable)

1. Acknowledgement Card along with the Registration No. is the proof of acceptance of the
Application Form (A/B/C) by the Admission Committee.
2. Acknowledgement Card shall not be issued unless the form is complete in all respects.
3. Acknowledgement Card shall therefore be the identity of the applicant for any inquiry, complaint,
or correspondence with the Admission Committee.
4. Admission Card, to be submitted to the institute to register the admission with the institute, shall be
given at the time of admission.
5. Admission card shall not be handed over to the applicant in case the original documents are not
submitted or the total fees payable are not paid at the time of admission.
6. Applicants granted admission during any round shall report to the respective institution within 3
working days of grant of admission, and obtain acknowledgement thereof, failing which their
admission is liable to be cancelled, and/or they may not be permitted to attend further admission
rounds.
 FORM GCET
ANNEXURE VII: APPLICATION FORM FOR GCET 2018
Recent Photograph
Roll No.
(Paste Here)
(Not to be filled by candidate)
INSTRUCTIONS:
i) Candidates are advised to read instructions overleaf carefully before filling the form.
ii) Applicant must fill this form in his/her own handwriting, after downloading &
printing this FORM from the website, on good quality A4 Size bond paper
and submit the same at the notified locations (as per Centre opted), on specified dates,
along with self attested copies of required documents.

NAME: (In CAPITAL LETTERS as it appears in SSCE certificate)

DATE OF BIRTH: (as in SSCE certificate) - -

PLACE OF BIRTH:________________________ GENDER: Male Female

(Tick the appropriate box)

ADDRESS: House No.__________________ Street Name/Area__________________

_________________________________________________________________________
Village/Town/City_______________________ Pin Code _____________State___________

PHONE NO

MOBILE
ACADEMIC DETAILS:
Exam Board Exam (Month/Year) Exam Seat No.
XII Science
GCET Subjects and Centre: Encircle appropriate boxes for the subjects opted, crossing out subjects not opted (X)
GCET SUBJECT CODE PY CH MA
GCET CENTRE CODE Centre name: -
Payment Details:
DD No. Bank Name: Dated:
DECLARATION
I, _____________________________________ state that I have read and accepted the provisions of the Prospectus and
GCET Rules, and have enclosed the self-attested copies of all the certificates required and submitted the application complete in
all respects. In the event of my application found to be incomplete and hence rejected by the admitting authority, I shall be held
responsible for the same.
I, hereby declare that the particulars furnished above are true, complete and correct to the best of my knowledge and
belief. I am fully aware that in the event of any information being false or incorrect and detected before or after the admission,
appropriate action as deemed fit by the Competent Authority can be taken against me.
PLACE: __________________ DATE:____________________

(Signature of the Applicant) (Name of Applicant)

(Signature of Parent/Guardian) (Name of Parent/Guardian)

INSTRUCTIONS TO BE FOLLOWED WHEN FILLING UP THE APPLICATION FORM

1. PHOTOGRAPH affixed on the form should be a recent one i.e. taken not earlier than 3 months prior to
the date of application. 2 additional identical passport size photographs are to be enclosed with this form.
2. Write your NAME in CAPITAL LETTERS and DATE OF BIRTH as it appears in your Secondary
School Certificate Examination (SSCE) certificate.
3.ADDRESS must be complete, including the postal code.
4.TELEPHONE NUMBER must be given with area code in brackets.
5.SUBJECT CODE: Encircle codes of subjects you intend to attempt

CODE SUBJECT
PY Physics
CH Chemistry
MA Mathematics
6. CENTRE CODE: Choose your centre by writing the centre code and name

S.No. Centre Code Address

1 Tiswadi 10 Dhempe Higher Secondary School of Arts & Science
Cujira(Bambolim)
2 Panaji 11 Goa College of Pharmacy
3 Verna 12 Fr. Agnel Multipurpose Higher Secondary School
4 Navelim 13 Rosary College / Higher Secondary of Arts & Commerce
5 Vasco 14 Deep Vihar High School
6 Mapusa 15 Purushottam Walawalkar Higher Secondary School
7 Ponda-1 16 A. J. De Almeida High School
8 Ponda-Farmagudi 17 G. V. M’s. Smt. N. J. Aguiar Higher Secondary School
9 Bicholim 18 Narayan Zantye College of Commerce
10 Curchorem 19 Smt. Chandrabhaga T. Naik Higher Secondary School
11 Porvorim 20 Vidya Prabodhini Higher Secondary School
12 Assagao 21 DM’s PVS Sarojini M. Kushe Higher Secondary School
13 Sanquelim 22 Govt. Higher Secondary School
14 Cuncolim 23 Maria Bambina Higher Secondary School
15 Dharbandora 24 BBSS Vishweshwar Shankar Laad Higher Secondary School
* Additional Centres may be notified as per requirement.
7. Self attested photo copies of the following CERTIFICATES to be enclosed:
a) SSCE Passing Certificate.
b) Std XIIth passing certificate or HSSC Examination Hall Ticket.
8.This Form should be accompanied by Demand draft for Rs. 1800/-payable at Panaji, in
favour of “Director of Technical Education” drawn on any Scheduled Bank, or any other
approved form of remittance, as may be duly notified. Dates for submitting completed forms:
2rd April, 2018 to 7th April, 2018.