THAPAR INSTITUTE OF ENGINEERING AND

TECHNOLOGY
BE/BTECH APPLICATION FORM
APPLICATION NO:
ENG/PCM/34641

Course Details
Qualification 12TH WITH PCM
Programme Type UNDERGRADUATE Programme Applied For B.E. OR B.TECH (4-YEARS) Category GENERAL PUNJAB

Personal Details
Applicant’s Full Name BHAVESHSEMWAL
Date of Birth 28/02/2004 Gender MALE
Email Address [email protected] Country INDIA
Do You Have Valid Punjab
Residency Certificate NO Mobile Number +91-9592239392
(Domicile Certificate)
Nationality INDIAN Aadhar Card Number 587833736517

Parent Details
Father Mother
Name MR.JAGDAMBA PARSHAD MRS.POONAM
Mobile Number +91-9417508021 +91-9023734472
Email Address
Annual Family Income UNDER 8 LAC
Annual Income 250000
Has your Father / Mother studied at TIET? NO

Address Details
Is Permanent Address Same As Address For Communication? : YES
Current Address ( For Communication) Permanent Address
Country INDIA INDIA
State PUNJAB PUNJAB
District PATIALA PATIALA
City PATIALA PATIALA
Address Line 1 HNO. 327 ADARSH COLONY BHADSON ROAD HNO. 327 ADARSH COLONY BHADSON ROAD
Address Line 2
Pincode 147001 147001

Xth Details
Year of System of Multiplying Grade Point /
Institute Name Board Roll No.
Passing Evaluation Factor Percentage
EVEREST PUBLIC PUNJAB SCHOOL
1019307146 2019 MARKS 92.76
SCHOOL EDUCATION BOARD
Name of the Qualifying Exam XIITH

XIIth Details
 Year of System of Multiplying Grade Point /
Institute Name Board Result Status
Passing Evaluation Factor Percentage
GOVT SENIOR SEC
PUNJAB SCHOOL
MODEL CIVIL LINES 2021 AWAITED
EDUCATION BOARD
PATIALA
Are you interested in International
Name of the State from where you've
PUNJAB Engineering (Credit Transfer) NO
appeared in the qualifying exam
Programme?

XIIth Centre Code

XIIth School Code
XIIth Roll Number
XIIth Admit Card ID
XIIth Index Number
XIIth Unique ID (UID)

PCM Details
Did you appear for an improvement exam? NO
Subject Maximum Marks Marks Obtained Percentage
1
2
3

PCB Details
Subject Maximum Marks Marks Obtained Percentage
1
2
3
PCM / PCB %age Marks

JEE Main Feb

Have you appeared for JEE Main Feb 2021? YES
Roll No. Application Number
1 PB08000746 210310493976

JEE Main March

Will you be appearing for further sessions of JEE 2021? JEE MAIN APRIL, 2021 ; JEE MAIN MAY, 2021
Roll No. Application Number
1

JEE Main April, 2021

Roll No. Application Number
1 PB08000994 210310493976

JEE Main May, 2021

Roll No. Application Number
1 210310493976

Diploma Details
Year of Result System of Grade Point /
Institute Name Course Multiplying Factor
Passing Status Evaluation Percentage

Interested In International Engineering (Credit Transfer) Branch Preference

Branch Preference Second
Preference 1 COMPUTER SCIENCE AND ENGINEERING (PATIALA CAMPUS) (B.E.)
Preference 2 COMPUTER ENGINEERING (B.E.)
Preference 3 COMPUTER SCIENCE AND BUSINESS SYSTEMS (B.E.)
Preference 4 ELECTRICAL AND COMPUTER ENGINEERING (B.E.)
Preference 5 ELECTRICAL ENGINEERING (B.E.)
Preference 6 ELECTRONICS (INSTRUMENTATION AND CONTROL) ENGINEERING (B.E.)
Preference 7 ELECTRONICS AND COMMUNICATION ENGINEERING (B.E.)
Preference 8 COMPUTER SCIENCE AND ENGINEERING (DERABASSI CAMPUS) (B.E.)
Preference 9 ELECTRONICS AND COMPUTER ENGINEERING (B.E.)

Other Details
Track Suit Size MEDIUM Blood Group A+
Are you suffering from any Are you influenced by any ranking(s) of
NO NO
chronic disease? Universities/Institutes/Colleges?
If yes, which ranking influenced What was your first source of information about admissions at Thapar
FRIENDS
you the most? Institute of Engineering & Technology?

Upload Documents
Upload Your Parent's Signature YES Upload JEE 2021 Admit Card YES
Upload XIIth Result NO Upload NEET Admid Card NO
Upload Improvement 12th Marksheet NO Upload XIIth Admit Card NO
Upload Passport Document NO Upload Domicile Document NO

Upload Reservation Document NO Upload Your Signature

Declaration
STUDENT'S DECLARATION:
I declare that

1. I have not been debarred from joining any educational institution or rusticated from the Institution/University/Board last attended.
2. All the statements made in this application are true to the best of my knowledge and belief. I clearly understand that if any of the statement
is subsequently found to be untrue, my admission to TIET would stand cancelled.
3. I have read the information Prospectus and Instructions incorporated therein carefully.
4. I have satisfied myself that I fulfill the minimum educational qualifications, physical and medical standard and that my admission be treated
as cancelled if found deficient in these standards.
5. I agree that admission may be granted to me on the terms and conditions stated in the latest edition of the Prospectus and Instruction of
TIET or such modifications thereof as may be made by the authorities.
6. I promise to abide by the rules and regulations of TIET as applicable from time to time. I undertake that so long as I am a student of TIET, I
will do nothing either inside or outside the campus that will interfere with its orderly working and discipline.
7. I am aware that ragging is totally banned, if found guilty of ragging, I would be liable to be punished as per rules and regulation of TIET/law
of land.
PARENT'S DECLARATION :
I declare that

1. My son/daughter/ward is seeking admission with my consent and in the event of his/her being admitted to the Thapar Institute of
Engineering & Technology, Patiala.
2. I will be personally responsible for (1) his/her good conduct and behaviour during his/her stay at TIET (2) return of the books issued to
him/her and I undertake to pay regularly all his/her fees, Hostel Mess and Canteen dues and other expenses incurred on campus and
educational tours, expenses to cover any breakage or damage of TIET’s
3. I also agree that he/she will submit to the discipline of TIET.
4. I am aware that ragging is totally banned and agree to abide by the punishment meted out to my ward in case he/she is found guilty of
ragging.

Applicant Name BHAVESH SEMWAL Parent Name JAGDAMBA PARSHAD

Date 14/07/2021