GAUTAM BUDDH TECHNICAL UNIVERSITY, LUCKNOW

(Formerly Uttar Pradesh Technical University, Lucknow)

APPLI CATI ON FORM FOR ADMI SSI ON TO M.TECH./ M.PHARM.
PROGRAMME
CHECKLIST
(Tick the Enclosed Documents. Please enclose only attested
COPIES. Please refer to the ADMISSION PROCEDURE for bringing
along the ORIGINALS for verification. Wherever applicable, mention
the CERTIFICATE NO. as prescribed in ADMISSION PROCEDURE)

Sl No Tick Particulars
1* Print out of On-Line Applicat ion Form (wit h phot ograph)
2* Demand Draft of Rs 1000= 00 (or Rs 500= 00) in favour of The Finance
Officer, Gautam Buddh Technical University, Lucknow payable at
Lucknow.
3* Dat e of Birt h Cert ificat e or t he High Scool (class X) Cert ificat e wit h Dat e of
Birt h.
4* SC/ ST/ OBC/ PH/ DOMI CI LE et c cert ificat es (all t hose are applicable).
5* Copies of degrees, marks/ grade sheet s of all t he examinat ions passed.
6* Medical Cert ificat e
7 Copy of GATE SCORE (if available)
8 No Obj ect ion Cert ificat e from t he employer (for employed applicant s).
9 Copies of publicat ions (if applicable).
Total No. of Enclosures : . No. of Sheets :
* : Required

Signat ure

Name






GAUTAM BUDDH TECHNICAL UNIVERSITY, LUCKNOW
(Formerly Uttar Pradesh Technical University, Lucknow)
M. TECH. and M. PHARM. PROGRAMME
ADMI SSI ON PROCEDURE
1. ADMISSIONS

1.1 Gaut am Buddh Technical Universit y, Lucknow (Formerly Ut t ar Pradesh
Technical Universit y ( UPTU), Lucknow) coordinat es and awards post
graduat e mast ers degree leading t o Mast er of Technology (M. Tech.)
and Mast er of Pharmacy ( M. Pharm.) Degrees in cert ain f ields of
specializat ion. The programmes are conduct ed at various inst it ut ions
approved by Universit y from t ime t o t ime.
1.2 The process of admissions t o t he M. Tech. and M. Pharm.
programme is cent rally coordinat ed by t he Universit y for all t he fields
of specializat ion and for all t he inst it ut ions list ed in sect ion 2.
1.3 Reservat ion in admission shall be governed by t he U.P. St at e Govt .
rules. I n case of non-availabilit y of suit able candidat es in any cat egory,
t he decision of Universit y for filling up vacant seat s shall be f inal.

2. COURSES OFFERED

2.1 M. Tech. Programme/ Institutions/ Intake
(i) Govt. / Govt. Aided Institutions
Institute
Code
Name of the
Institution
Stream of
Engineering/
Technology
Specialization of M. Tech.
Programme
Intake
042 M.M.M. Engineering
College, Gorakhpur
Civil 1. Environment al Engineering 18
Civil 2. Hill Area Development Engineering 18
Civil 3. Seismic Design & Eart hquake
Engineering
18
Civil 4. St ruct ural Engineering 18
Elect rical 5. Power Elect ronics and Drives 18
Elect ronics 6. Digit al Syst ems 18
Mechanical 7. Comput er I nt egrat ed Manufact uring 18
Comput er
Science
8. Comput er Science and Engineering 18

043 Bundelkhand I nst it ut e
of Engineering &
Technology, Jhansi.
Elect ronics 1. Digit al Communicat ions 20
Civil 2. Const ruct ion Technology &
Management
18
Mechanical 3. Manufact uring Science & Technology 18
Civil 4. Environment al Engineering 18
044 Ut t ar Pradesh Text ile
Technology I nst it ut e,
Kanpur.
Text ile 1. Text ile Technology 18
Text ile 2. Text ile Chemist ry 12
045 Harcourt But ler
Technological I nst it ut e,
Kanpur
Chemical 1. Chemical Technology wit h
specializat ion in Bio-Chemical
Engineering/ Food Technology/ Oil
Technology
34
2. Chemical Engineering 18
Mechanical 3. Comput er Aided Design 18
Elect ronics 4. Elect ronics & Communicat ion
Engineering
18
052 I nst it ut e of Engineering
& Technology,
Lucknow.
Civil 1. Environment al Engineering 18
Bio-Technology
2. Bio-Technology 18
Elect ronics 3. Micro-Elect ronics 15
104 Kamla Nehru I nst it ut e
of Technology,
Sult anpur.
Elect rical 1. Power Elect ronics & Drives 18
Mechanical 2. Thermal Engineering 18
Civil 3. Geot echnical & Environment al Engineering 18
Comput er
Science
4. Comput er Science & Engineering 18
190 DOEACC Cent re,
Gorakhpur
Elect ronics 1. Elect ronics Design and Technology 18

(ii) Private Institutions
Institute
Code
Name of the
Institution
Stream of
Engineering
Specialization of M. Tech.
Programme
Intake
010 Unit ed College of
Engineering and
Research, Allahabad
Comput er
Science
1. Comput er Science & Engineering 18
014 Sri Rammurt y Smarak
College of Engineering
& Technology, Bareilly
I nt er-disciplinary 1. Comput er Aided Design and Comput er
Aided Manufact uring ( CAD-CAM)
15
Comput er
Science
2. Soft ware Engineering 15
Elect ronics 3. Microwave Engineering 18
053 Azad I nst it ut e of
Engineering &
Technology, Lucknow
Mechanical 1. Advanced Comput er Aided Design

18
Elect ronics 2. Elect ronics, I nst rument at ion & Cont rol
Engineering
18

123 Saroj I nst it ut e of
Technology &
Management , Lucknow
Comput er
Science
1. Comput er Science & Engineering 18
Elect ronics 2. Elect ronics & Communicat ion
Engineering
18
Elect rical 3. Power Elect ronics 18
Mechanical 4. Thermal Engineering 18
138 B.B.S. College of
Engineering &
Technology, Allahabad
Mechanical 1. Advanced Comput er Aided Design 18
145 College of Science &
Engineering, Jhansi
Comput er
Science
1. Comput er Science & Engineering 18
Elect ronics 2. Elect ronics & Communicat ion
Engineering
18
165 Kanpur I nst it ut e of
Technology, Kanpur
Comput er
Science
1. Comput er Science & Engineering 18
Elect ronics 2. Elect ronics & Communicat ion
Engineering
18
Second Shift
053 Azad I nst it ut e of
Engineering &
Technology, Lucknow
Comput er
Science
1. Comput er Science & Engineering 18
I nformat ion
Technology
2. I nformat ion Technology 18

2.2 M. Pharm. Programmes / Institutions / Intake Private Institutions
Institut
e Code
Name of the Institution Specialization of M. Pharm.
Programme
Intake
041 Archarya Narendra Dev College of Pharmacy, Gonda 1. Pharmaceut ical Chemist ry 10
054 Babu Banarasi Das Nat ional I nst it ut e of
Technology & Management , Lucknow
1. Pharmaceut ics 18
2. Pharmaceut ical Chemist ry 18
3. Pharmacognosy 10
056 Nort hern I ndia Engineering College, Lucknow 1. Pharmaceut ical Chemist ry 10
123 Saroj I nst it ut e of Technology & Management ,
Lucknow
1. Pharmaceut ical Chemist ry 18
2. Pharmacognosy 18
164 Pranveer Singh I nst it ut e of Technology,
Kanpur
1. Pharmaceut ical Chemist ry 18
2. Pharmaceut ics 18
167 Raj arshi Rananj ay Sinh College of Pharmacy,
Amet hi, Sult anpur
1. Pharmaceut ics 18
186 Kamla Nehru I nst it ut e of Management &
Technology, Sult anpur
1. Pharmaceut ical Chemist ry 10
188 Advance I nst it ut e of Biot ech & Paramedical
Sciences, Kanpur
1. Pharmaceut ics 18
2. Pharmaceut ical Chemist ry 18
202 Hygia I nst it ut e of Pharmaceut ical Educat ion
and Research, Lucknow
1. Pharmacology 18
2. Pharmaceut ics 18
203 Rameshwaram I nst it ut e of Technology & 1. Pharmacology 18
Management , Lucknow
2. Pharmaceut ics 18
236 Sir Madan Lal I nst it ut e of Pharmacy, Et wah 1. Pharmaceut ics 18
2. Pharmacology 18
Second Shift
197 Azad I nst it ut e of Pharmacy & Research,
Lucknow
1. Pharmaceut ics 18
2. Pharmaceut ical Chemist ry 18

3. ELIGIBILITY CRITERIA:

3.1. The applicant for M. Tech./ M. Pharm. programmes must fulfill t he
following crit eria:

i. General/ OBC candidat es, wit h 60 % marks in graduat ion in Engineering
or Technology/ B. Pharm. or equivalent , are eligible.

ii. SC/ ST candidat es, wit h 55 % marks in graduat ion in Engineering or
Technology / B.Pharm. or equivalent , are eligible.

iii. For admission t o M.Tech. (Comput er Science, I nformat ion
Technology and relat ed branches), candidat es having degree of
MCA, M.Sc.( Comput er Science) or M.Sc. ( I nformat ion Technology) wit h
at least 60% marks for General/ OBC candidat es and 55% marks for
SC/ ST candidat es are also eligible.

iv. For admission t o M.Tech. ( Elect ronics Engineering and relat ed
branches), candidat es having degree of M.Sc. (Elect ronics) wit h at
least 60% marks (f or General/ OBC candidat es), and 55% marks
(for SC/ ST candidat es) are also eligible.

v. For admission t o M.Tech. ( Chemical Technology and relat ed branches),
candidat es having degree of M.Sc. (Chemist ry) wit h at least 60% marks
(for General/ OBC candidat es), and 55% marks (f or SC/ ST candidat es) are
also eligible.

vi. For admission t o M.Tech. (Hill Area Development Engineering) /
M.Tech. (Environment al Engineering), B.Tech. / B.E. or equivalent in any
branch of engineering / t echnology OR B.Arch. or equivalent . OR M.Sc. in
any discipline or Mast ers degree in Mat hemat ics / Geography wit h at least
60% marks (for General / OBC candidat es), and 55% marks
(for SC/ ST candidat es) are also eligible.

Candidat es not having Mat hemat ics at I nt ermediat e level shall be required
t o compulsorily qualif y a non-credit course on Mat hemat ics of
I nt ermediat e level in t he first semest er of M.Tech. programme.

vii. For admission t o M.Tech.(Bio-Technology) , candidat es having degree of
M.Sc. in Physical / Chemical / Biological / Vet erinary/ Agricult ural Science or
Biot echnology or Bioinformat ics or equivalent degree in relevant
disciplines or B.E. / B.Tech. in Chemical / Bioinformat ics / Biochemical
/ Food/ Agricult ure/ Environment al or equivalent degree in
relevant discipline or MBBS / B. Pharm./ B. V. Sc./ B.D.S wit h at least
60% marks (for General / OBC candidat es), and 55% marks (f or
SC/ ST candidat es) are also eligible.
viii. For admission t o M.Tech. (Plast ic Engineering) , candidat es having degree
of B.Tech./ B.E. in Chemical Engineering/ Chemical Technology / Polymer
Science & Technology / Mechanical Engineering / Product ion Engineering/
Pet rochemical Technology or equivalent of above degrees / course or
M.Sc. Chemist ry / I ndust rial Chemist ry / Polymer Science wit h at least
60% marks (for General / OBC candidat es), and 55% marks (for SC/ ST
candidat es) are also eligible.
ix. For admission t o M.Tech. ( CAD-CAM), candidat es must have B.Tech./ B.E.
in Mechanical Engineering/ Aut omobile Engineering / Chemical
Engineering/ Chemical Technology / Civil Engineering or allied branches
wit h at least 60% marks (f or General / OBC candidat es), and 55% marks
(for SC/ ST candidat es).
x. For admission t o M.Tech. (Aut omat ion & Robot ics), candidat es must have
B.Tech. / B.E. in Mechanical Engineering/ Elect rical Engineering/
Elect ronics & Communicat ion Engineering / Comput er Science &
Engineering or allied branches wit h at least 60% marks ( for General /
OBC candidat es), and 55% marks ( for SC/ ST candidat es).

3.2 The equivalency of any degree for admission t o any programme will be decided
by t he Universit y. The eligibilit y crit eria given above are minimum and mere
possessing t he same does not qualify t he eligibilit y f or admissions. Universit y
may prescribe any ot her requirement s over and above t hese condit ions.

4. SELECTION PROCEDURE

4.1 The candidate has to fill an application form on-line wit h all t he
relevant det ails and send print copy of t he same along wit h requisit e fee
and cert ified copy of document s relat ed t o qualificat ions on or before t he
last dat e prescribed by t he Universit y. The on-line applicat ion is available
on websit e www.upt u.ac.in. The candidat es should f ill in and sign t he
check list and submit along wit h t he form.
4.2 The sort -list ed eligible candidat es shall be called for counselling. The
schedule of counselling will be available on t he Universit y websit e
www.upt u.ac.in.
4.3 The number of seat s, programmes & inst it ut ions may change under very
special circumst ances. The same will be post ed on t he websit e of t he
universit y.
4.4 Students having domicile of Uttar Pradesh shall be given first
preference and subsequently the candidate having domicile
outside U.P. will be considered only if seats are vacant/ unfilled.
4.5 Candidat es wit h qualif icat ions st at ed in Sect ion 3 and wit h valid
GATE/ GPAT scores will be given first preference in admission.
4.6 Graduat es in Engineering / Technology wit hout valid GATE/ GPAT scores
will be given second preference in admission.

5. RESERVATIONS: Reservat ion shall be applicable as per t he St at e Govt .
norms as prescribed by t he Technical Educat ion Depart ment .


6. MEDICAL STANDARDS
6.1 Candidat es called for counseling will have t o submit an undert aking f or Medical
fit ness on Cert ificat e Number- 8.
6.2 The candidat e should have t o submit Medical cert if icat e on proforma given as
Cert if icat e Number - 9 at t he t ime of admission in t he college allot t ed.
Physically Handicapped / Disabled:
Type I Minimum 40% permanent Visual impairment
Type II Minimum 40% permanent Locomot ors disabilit y
Type III Minimum 40% permanent speech and Hearing
impairment

7. COUNSELING
7.1 Counseling shall be held at G.B. Technical Universit y (formerly U.P. Technical
Universit y, Lucknow) , I ET Campus, Sit apur Road, Lucknow. The information
about counseling schedule, procedures and list of sort listed
candidates will be available on website: www.uptu.ac.in. only after
8
th
August, 2011. NO separate counseling letter shall be sent. The
candidates are advised to visit website frequently for counseling
details.
7.2 The candidat es called for counseling will be required t o come wit h original
cert ificat es of qualifying examinat ion, mark sheet , weight age cert ificat e,
domicile and cat egory/ reservat ion cert ificat es et c. wit h one at t est ed copy of
each. I n case t he candidat es do not submit t he proper cat egory/ reservat ion
cert ificat e in t he prescribed proforma at t he t ime of counseling, t he advant age
of reserved cat egory shall not be provided and t hey will be t reat ed in General
Cat egory. I f a candidat e has passed qualifying examinat ion from out side of
U.P., he/ she has t o bring t he domicile cert ificat e of his/ her parent s (Fat her or
Mot her) only at t he t ime of counseling. The candidate must note that
his/her domicile certificate is not acceptable, in place of his parents
certificate and no request shall be entertained for relaxation.
7.3 Verif icat ion of original document s shall be carried out at t he t ime of counseling.
The candidat es will not be considered for admission if he/ she does not submit
t he original document s at t he t ime of counseling. However t he originals will be
ret urned t o candidat e aft er verificat ion.
7.4 The init ial fee of Rs. 5,000/ - will be deposit ed at counselling cent re in t he form
of Bank draft . This fee is adj ust able against t ot al fee payable at I nst it ut ion if
candidat e t akes admission at allot t ed inst it ut e. The init ial fee of Rs. 5,000/ - will
be forfeit ed if t he candidat e does not t ake admission in t he allot t ed inst it ut ion.
Request s for ret urn of t his fee in such case will not be ent ert ained.
7.5 I n addit ion t o init ial fee t he candidat e called for counselling has t o deposit a
separat e bank draft of Rs. 500/ - as counselling fee. This counselling fee is non-
refundable.
7.6 All t he Bank draft s must be prepared separat ely and drawn in favour of
Finance Officer, G. B. Technical University, Lucknow payable at
Lucknow.

8 DOCUMENTS REQUIRED AT THE TIME OF COUNSELLING
The candidat es are required t o bring t he following document s, in original along
wit h one set of phot ocopies wit h t hem at t he t ime of Counseling:
(a) High School Cert if icat e.
(b) Mark sheet s of qualifying examinat ion.
(c) Valid GATE Score Card
(d) Cat egory and Subcat egory cert ificat e(s), if applicable.
(e) Passport size Phot os. (2 Nos.)
(f) Domicile Cert ificat e
(g) Medical Cert ificat e / Undert aking

9 DOMICILE REQUIREMENTS
9.1 Candidat es, who have passed t he qualifying examinat ion from an inst it ut ion
locat ed in t he St at e of Ut t ar Pradesh and who do not claim for any reserved
cat egory are eligible for admission t o all t he courses at all t he inst it ut ions
against available General (OPEN) seat s (No cert ificat e required).
[ Code: UPGE]
9.2 Candidat es, who have passed t he qualifying examinat ion from an inst it ut ion
locat ed in St at e of U.P.; and are domicile of U.P.; and belong t o Schedule Cast e
(SC) of U.P. / Schedule Tribe (ST) of U.P. / Ot her Backward Classes of U.P. are
eligible for admission against available reserved seat s of t heir cat egory.
Cert if icat e no. 1 or 2 as applicable is required. List of SC, ST and OBC cast es as
per SC/ ST Act 1976 and Government Order 4/ 1/ 2001-TC/ Ka-2/ 2002 dt .
19/ 09/ 2002 is at t ached in Appendix E.
[ Respect ive Codes: UPSC / UPST / UPBC]
9.3 Candidat es, who have passed t he qualifying examinat ion from an inst it ut ion
locat ed out side U.P.; and whose parent s are domicile of U.P.; and who have
not claimed for any reserved cat egory, are also eligible for admission t o courses
offered at all inst it ut ions under General (OPEN) cat egory. Such candidat e has
t o produce t he domicile cert if icat e of his/ her parent s (Father or Mother only)
at t he t ime of counseling (cert ificat e no. 3) .
[ Code: UPGD]
9.4 Candidat es, who have passed t he qualifying examinat ion from an inst it ut ion
locat ed out side U.P.; and whose parent s are domicile of U.P.; and who belong
t o Schedule Cast e of U.P. / Schedule Tribe of U.P. / Ot her Backward classes of
U.P. are also eligible for admission against reserved seat s of t heir cat egory.
Such candidat e has t o produce t he domicile cert ificat e of his/ her parent s
(Father or Mother only) (cert if icat e no. 3) and cat egory cert ificat e (no. 1 or
2 as applicable) at t he t ime of counseling. List of SC, ST and OBC cast es as per
SC/ ST Act 1976 and Government Order 4/ 1/ 2001-TC/ Ka-2/ 2002 dt . 19/ 09/ 2002
is at t ached in Appendix E.
[ Respect ive Codes:
GDSC/GDST/GDBC]
9.5 The domicile requirement to son/daughter of following is relaxed and
admission is permitted to such
(i) Defense personnel set t led in U.P. on t he dat e of Ent rance Examinat ion aft er
ret irement / being disabled in act ion or Defense personnel killed in act ion and
t he dependent s set t led in U.P. on t he dat e of Ent rance Examinat ion. Cert ificat e
no. 5 is required.
(ii) Defense personnel who are not domicile of U.P., but are post ed in U.P. on t he
dat e of Ent rance Examinat ion. Cert ificat e no. 5 is required.
(iii) Employee of All India Services belonging t o U. P. cadre. Cert ificat e no. 11 is
required.
[Code: GDDA]

Proforma of various certificates are available in Appendix A

10. OTHER INFORMATIONS

1. I ncomplet e applicat ions will be rej ect ed.
2. No TA / DA will be admissible t o t he candidat es called f or counseling.
3. The decision of t he Universit y for t he select ion of candidat es shall be f inal.

11. INSTRUCTIONS FOR FILLING ON-LINE APPLICATION FORM
Select any of t he courses ( M. Tech. or M. Pharm.) from t he Course Dropdown.
Aft er select ing t he course, t he relat ed specializat ion opt ions would appear in t he
Specializat ion sect ion.
Select Specializat ion as per your choice by clicking on t hem and you can select
mult iple specializat ion by pressing cont rol but t on on t he keyboard and select ing t he
specializat ion or you can select it one by one also.
Aft er making t he select ions click t he Right Arrow but t on on t he screen t o
move t hem in t he select ion list pane.
I f you want t o remove some of t he specializat ions from t he select ion pane, select by
clicking on it and click t he Left Arrow but t on on t he screen t o move t hem
back int o t he Select Specializat ion field.
Aft er making t he complet e select ion, click on t he Submit but t on t o navigat e t o t he
Form page for filling t he applicat ion.
Click Reset but t on t o clear all t he select ed fields on t his page, in-case of any
mist ake.
On t he Form page, fill in t he Draft number , Name of t he draft issuing bank , Dat e
of I ssue ( DD/ MM/ YYYY format ) and Amount from t he dropdown ( Rs. 500 or Rs.
1000)
Then fill in all t he part iculars of t he candidat e viz. Name, Dat e of Birt h, Fat hers
name, Address, Telephone, Mobile, Fax and Email along wit h t he cat egory, Sub-
Cat egory, Gender, Domicile and Nat ionalit y (I ndian or Ot hers) .
Furt her, fill in t he Part iculars of Qualificat ions which is Examinat ions passed,
Subj ect / Branch, Name of Universit y/ I nst it ut ion, Year of Passing, Division and
Percent age of Marks . Fill in t he t ill-dat e aggregat e t ot al in case for t he candidat es
who have appeared for t he final examinat ion and are wait ing for t heir final result .
Fill in your GATE score det ails, if available.
Fill in t he field Place , Upload your Phot ograph by clicking t he Browse but t on and
select ing your scanned Phot ograph saved on t he hard-drive of your syst em. MAKE
SURE THAT THE PHOTOGRAPH IS IN JPEG FORMAT AND IT SHOULD NOT
BE MORE THAN 100 MB.
Click and check t he Checkbox for t he declarat ion from t he st udent t hat at all t he
informat ion furnished is correct t hen click Submit but t on t o submit t he filled form.
Click Reset but t on t o clear all t he filled fields on t his page, in-case of any mist akes
or if you want t o fill t he un-submit t ed Form again.
Click here to download the CHECKLIST which you would be required to
send along with the printout of this form.

AppendixA



CERTIFICATE 1 (sii si)

~- = l-- il--il- (UPSC/UPST/GDSC/GDST)
{4it + - fn + fni faa/si it faa zii sifia)


t nili- l+i i-i t l+ i+ c ...........................................................................
z zi i ........................................ l-i=i nizit .............................................
-t=in ................................................. lni ........................................... <zi ........
............. +i -n ................................ il- n t ~i ii ~i t il- ~- = l--
il--il- ~i< zi (= zii i-) (+ +:- + ~--n - ii- =+i-- < zi zii=- ..................
................................... =+i ,ii ni- ~- = l-- il--il- t


~ii + t--i-i t--i-i
l<-i + -in
-ii- nit
lni ~li+ii~l-l+- lni
~li+ii
l=i nl-n-i nl--t=in<i
Note: Proforma of certificate shall be changed according to latest Govt. order.







CERTIFICATE 2 (sii sz)

a-a s<zi + -4 fs n + fny ifa sii s +i ss
(UPBC/GDBC)


t nili- l+i i-i t l+ iin-i +nii .................................................................
= z= zi i .....................................................................................l-i=i n in .......
............................................. -t=in ........................................ -n ........................
.... lni ............................................. -- <zi i +i ......................................
lzi il- + l+- t t il- -- <zi ni+ =i ~-=l-- il-i ~-=l-- -il-i
-ii lz ni + ln( ~i-ii ~lil-n. +- +i ~-=-i + + ~--n- ni--i i-- t
t ii nili- l+i i-i t l+ iin-i+ nii ..............................................................
................ -+- ~lil-n +- +i ~- = -i . (~li= --i = i ..+-.+i c.+: ic
=ic l<-i + l<=-. +: ,ii ii = ziili-) = ~i-zil<- -ti t
iin-i+ nii ................................................................ -ii ~ii --+i li --
< zi + n in ..................... iin-i+ nii ....................................... -n ..................
.......................... lni ................................... n =ini--i t-i t


~ii + t--i-i t--i-i
l<-i + -in
-ii- nit
lni ~li+ii~l-l+- lni
~li+ii
l=i nl-n-i nl--t=in<i
aia ~ii i- < l+ -cc + ~- lz n + ln( il- nii sn oi, zoii +
z-i- +i -i t~i ti-i ~iz+ t +il+ + inin + ~--n- ~i- in ~lii +i
~i-ii +i nii ~-n- -ti t






CERTIFICATE - 3 (izek.k i=&3)*
a-a s<zi n faiut + s / st (UPGD/GDSC/GDST/GDBC)
{au fn + fri+it zii sifia fu fn + iai/fsai faiut r)

4r sifia f+4i iai r f+ t/tat {4it + fsai/iai +i ai) ...................
...................................fsai/iai t/+o{4it +i ai)....................................
............................................. a-a s<zi + ni/zir ..................................
...... arutn .............................................fni ..................................... +
n faiut r aii t/+o {4it +i ai) ......................................................
..........sa fsai/iai s sia4i ifa r+ aa sa s t/+o {4it +i ai) ..
...........................................................+ iai/fsai uii-4a faiu +a r+


l<-i+ t--i-i lni nl-
-ii- i -in
<-in
nt
(lni nl- +i =in)

*fni faa ii fni faa zii fria s fni faa/u fta faa zii
sii si rt i-4 rin i ziioio uoisz/ata zoozz{II)/s f<ai+ is +t, zoo +
rita it f+4i i4ni+

aianii z. ~ii + ni-il-i +i -i ti-i -ilt( +il+ ~ii l-ti- ~t+ii i-ii --
< zi + it l-i- l+=i lin = --ii +i t -- --+ ni-il-i -- <zi + nn-ii:
l-i=i t













CERTIFICATE 4 {sii s 4) (Sub-Category UPFF)

a-a s<zi ni+ ui {ziitf+ =s u f+nin, aai uni uaiat +
ifai i ias ufa+i + fny i+ii) frifa4, i + aui
a-ai uni uaiat + ifa + sii s +i ss

sifia f+4i iai r f+ t/tat {aiai uni uaiat +i ai) ..................................
............. faiut ni ........................................arutn .........................................
. an .................................................. fni ........................................ a-a s<zi
ni+ ui {ziitf+ =s u f+nin, aai uni uaiat + ifai i ias ufa+i +
fny i+ii) frifa4 i + aui a-ai uni uaiat r i t/tat/+o{ifa
4it +i ai) ........................................................................... s/st/si/
fifra sit asif+a frifa4, i + rt siriiai + aui aa t/tat {a-ai
uni uaiat) .............................................................. + ifa r+


l<-i+ t--i-i
-ii- i -in ( -i<-in
nt (lni nl- +i =in)
Note: Proforma of certificate may be changed according to latest Govt. order.
















CERTIFICATE 5 (izek.k i=&5)

a-a s<zi/uai <n (Sub-Category UPAF)
{fa 4faa + if+u +if-n/fni ufa+ +4ii i zii sifia)

t nili- l+i i-i t l+ iin-i {4it + fsai ii iai +i ai) .................
......................l-i=i nizit .................................................. -t=in .......................
....................... lni ..................................-- < zi. + l<-i + ..............................+i
=i l-- (Superannuated) z n ni n~n ti n-- <zi n -ni- n --i- t
ii-i in= -in= -ii = -i + -ii- ...................................................... l<-i +.............
............. = l<-i + .......................... -+ +i - i t


l<-i+ l- +nil-n ~il+= + t--i-i
-ii- -in
-it

(fni faa zii sifia)

t nili- l+i i-i t l+ i+c(~ii ) ........................................................ l-i=i
................................. -- < zi ni zit .............................. -t=in ........................
... lni ................................... -i+- =-i <n + =i l-- (Superannuated) z n
ni n i ~n ti n +n-ii i -- <zi + -iii l-i=i ti. + zzi t --
<zi ii-i in=-in = -ii =-i n +i- it


l<-i+ t--i-i
-ii- -in
nit










CERTIFICATE 6 (izek.k i=&6) (Sub-Category UPHC)
dkmfUlfyax esa tek djus gsrq

ziitf+ f+nin + friia + fny sii s
{4 ff+-ui fri+it zii sifia)

+. t nili- l+i i-i t l+ i+ c(~ii ) ............................................
......................... z zi i (l-i +i -in) .............................................
................-i- lni +iii = ziiil+ = l+ni n t
(+ n n l-l+=i ~li+ii ti +ii lni )..................................................
................................................................................................................
.. ~ii +i -i+- l+nin-i +i l--- +i +i l+ni n-i +i ii n ii i
=+-i t
(+ i +i l-zii- nni)
Type - I: Minimum 40% permanent Visual impairment
Type-II: Minimum 40% permanent Locomoter disability
Type-III: Minimum 40% permanent Speech Hearing impairment
.. t ii nili- l+i i-i t l+ -i+- l+ni n l-il- ~ii +
:-il-l n lzi-ii i-- +- n ii+ -ti ti ni


~ii + t--i-i l-l+=ili+ii + t--i-i
-in -in
l<-i+ nt













CERTIFICATE 7 (sii sz)
* FORMAT FOR MEDICAL CERTIFICATE
(To be obtained from a Chief Medical Officer or Medical Officer of a participating U.P. State Funded Engineering
Institute)

This certificate has to be submitted at the time of admission in the college allotted.

( To be filled in by the Candidate )
Name of Candidate: Age: Sex:
Category: Subcategory :
Father's Name:

L.T. M.I.
Height Weight Chest Abdomen
V
I
S
I
O
N
Colour Vision:
Without glass:
With glass:
History Operation Kockh's Colics B.P.

Seizures Asthma Piles Diabetes
E
X
A
M
I
N
A
T
I
O
N
Pulse Tonsil DNS Hernia

Pallor L.Nodes CSOM Hydrocele
Cardiovascular CNS

Respiratory GIT

Genitourinary Others
Is the candidate physically handicapped/Disabled: (Please tick) Yes / No
If yes, type of handicap/disability:
Type-I: Minimum 40% permanent Visual impairment
(Please trick the type of handicap/disability) Type-II: Minimum 40% permanent Locomotors disability
Type-III: Minimum 40% permanent speech and
Hearing impairment
Any other finding:
Certified that the candidate is physically fit/unfit/temporally disqualified to pursue engineering studies




Signature of Candidate Signature of the issuing Medical Officer ( with
Official stamp)


CERTIFICATE 8 (sii ss)
UNDERTAKING BY CANDIDATE FOR MEDICAL FITNESS

I certify that I have no such physical handicap/disability which would hinder the pursuit of
studies in the courses in which I am seeking admission. If at stage it is found that I have a
physical handicap/ disability which would hinder the pursuit of studies in the courses in
which I am seeking admission then my admission will be liable to be cancelled. I will produce
medical fitness certificate from a C.M.O./C.M.S. at the time of my joining the institution
allotted by GBTU-counseling.


Date: Counter Signed by Father / Guardian Signature of the Candidate