Application form for VITEEE- 2012

Full Name
Date of Birth Mode of Study Community Month & Year passing XII Board School Address Permanent Address

: AYUSH JAGGI
: 28/10/1994 : REGULAR : GENERAL/OC : APR - 2012

Application. No. : 2012343467

Gender Nationality Email ID Religion : MALE : INDIAN : jaggi.ayush9@gmail.com : HINDUISM Native Landline Mobile No. Qualifying Exam Test City : UTTAR PRADESH - 36 : 0120 - 2761323 : 8826240229 : 12th Class : DELHI - 124

Parent/Guardian Name : ASHOK KUMAR JAGGI

Reg.No. / Roll.No. :

: 04 - CENTRAL BOARD OF SECONDARY EDUCATION

: DELHI PUBLIC SCHOOL GHAZIABAD ,SITE-3 MEERUT ROAD,GHAZIABAD,UTTAR PRADESH - 201003

: 1/157 SECTOR-1 ,CHIRANJIV VIHAR, GHAZIABAD, UTTAR PRADESH - 201002

DECLARATION I solemnly and sincerely affirm that I am an Indian National and that all particulars furnished by me in this application form are true and correct . I have not concealed any information. However, in the event of any information being found to be incorrect, fraudulent or untrue, either before or after the examination or after my admission to the programme, I understand that I am liable to face criminal prosecution and the management can claim all authority to cancel my candidature / selection or admission as the case may be and I would have to forego my seat and the fees. I agree to abide by the rules and regulations governing the examination as well as the rules pertaining to the refund of tuition and hostel fees contained in the brochure. I further undertake to submit all the required certificates as per the rule, either at the time of interview or during the admission process, failing which I understand that I would have to forego my seat and the fees.

Paste here firmly your recent color passport size photograph of good quality.

Date : Place : Signature of Parent / Guardian Signature of the Applicant

___________________________________________________________________________________________________________________________________________________________

Beyond this point, the applicant has to fill in his / her own handwriting.

Note:- Kindly enclose the DD along with the application form.

Payment - Demand Draft Details

DD Amount of Rs.900/- for Indian Candidates and 50 USD for NRI Candidates drawn in favour of 'VIT University' payable at VELLORE from ____________________________________ Bank/Exchange, DD.No.___________________, dated,_________________.

VITEEE - 2012 Application. No. : 2012343467 Applicant Name : AYUSH JAGGI

BY REGISTERED POST / SPEED POST ONLY

To
Mode of Payment
Demand Draft ( DD ) Challan

: :

Net Banking (Indianbank)

THE ADMISSIONS OFFICER, VIT University, Vellore - 632014, Tamil Nadu, INDIA.

-------------------------------------------------------------------------------------------------------------------------------------------------------- The Above address may be pasted on the envelope

Student Copy

PLEASE INSERT THE APPLICATION FORM IN THE ENVELOPE IN SUCH A MANNER THAT THE BARCODE ON THE APPLICATION FORM IS NOT FOLDED.

CHECKLIST FOR THE CANDIDATE

1.Tick the box if you have enclosed the following documents: a. Completed Application Form with your signature. b. Completed Application Form with your parent's / Guardian's signature. c. Your color photograph (of size 3.5 cm x 4.5 cm) affixed on application appropriately. d. Have you entered your correct Date of Birth. 2.Retain a photocopy of the completed application form with you. 3.Send your application form to the VIT as mentioned on the address slip