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    Application Form For VITEEE - 2015: Full Name Soumya Roy Choudhury Application. No.: 2015016070

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    SoumyaRoyChoudhury
    This document contains an application form submitted by Soumya Roy Choudhury for VITEEE - 2015. It includes his personal details like name, date of birth, gender, religion, address, contact details, parent details, choice of campus, education details and declaration agreeing to abide by the rules of the exam. It also contains an acknowledgement of online payment of Rs. 940 as application fee on December 2, 2014 for application number 2015016070.

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    Application Form For VITEEE - 2015: Full Name Soumya Roy Choudhury Application. No.: 2015016070

    Uploaded by

    SoumyaRoyChoudhury
    26 views1 page
    This document contains an application form submitted by Soumya Roy Choudhury for VITEEE - 2015. It includes his personal details like name, date of birth, gender, religion, address, contact details, parent details, choice of campus, education details and declaration agreeing to abide by the rules of the exam. It also contains an acknowledgement of online payment of Rs. 940 as application fee on December 2, 2014 for application number 2015016070.

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    This document contains an application form submitted by Soumya Roy Choudhury for VITEEE - 2015. It includes his personal details like name, date of birth, gender, religion, address, contact details, parent details, choice of campus, education details and declaration agreeing to abide by the rules of the exam. It also contains an acknowledgement of online payment of Rs. 940 as application fee on December 2, 2014 for application number 2015016070.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    26 views1 page

    Application Form For VITEEE - 2015: Full Name Soumya Roy Choudhury Application. No.: 2015016070

    Uploaded by

    SoumyaRoyChoudhury
    This document contains an application form submitted by Soumya Roy Choudhury for VITEEE - 2015. It includes his personal details like name, date of birth, gender, religion, address, contact details, parent details, choice of campus, education details and declaration agreeing to abide by the rules of the exam. It also contains an acknowledgement of online payment of Rs. 940 as application fee on December 2, 2014 for application number 2015016070.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    Application form for VITEEE - 2015

    Full Name

    : SOUMYA ROY CHOUDHURY

    Application. No. : 2015016070

    Date of Birth

    : 16/04/1997

    Gender

    : MALE

    Religion

    : Hinduism

    Nationality

    : Indian

    Community

    : General/OC

    Mother Tongue

    : Bengali

    Native State

    : Assam

    Mode of Study

    : Regular

    Landline No.

    : -

    Mobile No.

    : 9864853488

    Parent name

    : DULAL ROY CHOUDHURY

    Hostel

    : Yes

    Choice of Campus

    : Vellore

    Email ID.

    : [email protected]

    Qualifying Exam

    : 12th Class

    Month & Year Passing

    : Mar - 2015

    Exam Roll.No./Reg.No.

    Testcity

    : GUWAHATI

    Permanent Address

    : 22, NAYAN NAGAR,GUWAHATI,KAMRUP,ASSAM,781026.

    Name of the School

    : MARIAS PUBLIC SCHOOL

    Address of the School

    : BIRKUCHI, GUWAHATI, KAMRUP,ASSAM, 781026.

    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 counselling or during the admission process, failing which I understand that I
    would have to forego my seat and the fees.
    I have read the brochure and understood the contents in general and the method of
    Equipercentile Equating in particular.
    I accept this method to be adopted for Merit List preparation by VIT.

    Signature of the Applicant

    Payment Acknowledgement Copy


    VIT ONLINE APPLICATION SALE

    Payment Option Made:-NetBanking / Credit Card / Debit Card.


    Bank Reference No.:201412026765339

    Transaction No.:130789194

    Applicant Name:SOUMYA ROY CHOUDHURY

    Application No.:2015016070

    Contact No.:9864853488

    Transaction Date:02-12-2014 10:58:39

    Application Fee :

    940.00 (excluding bank charges.)

    Amount in words: Rupees Nine Hundred And Forty Only.


    Note :
    1. Do not send the hardcopy of the application form.
    2. Retain a photocopy of the completed application form with you.

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