Application
Application
Application
Nationality: Indian 9. First Attempt at JEE: In 2012 12. Enlarged Font Paper Required: No 15. Address: Infront Of Kesarvani Sewasadan,H.No-533 Krishna Nagar, Satna M.P 16. PIN Code: 485001 21. Type of Preparation: Self 23. Board of QE: Others 25. Parents' Educational Background: Both Graduates 27. Annual Income of Parent/Guardian: Rs.1,00,000 - 4,50,000 22. Place of 10th Class Schooling: City 24. Mother Tongue: Hindi 26. Occupation of Parent/Guardian: Business 3.5 cm x 4.5 cm with the face covering about 75% of the photo 4. Gender: Female 7. Year of Passing 10th Class: 2010 10. Question Paper Language: English 13. Entitled for DS Seat: No 17. Email ID: [email protected] 18. Mobile No: 08109329901 19. Landline No: 07672416026 20. PIN Code of Permanent Residence: 485001 PASTE RECENT COLOR PHOTOGRAPH HERE 5. Category: GE 8. Year of Passing QE: Appearing in 2012 11. Physically Disabled: No 14. Choice of Exam Cities: I. Bhopal (401) II. Jabalpur (403)
Place : ...................... Date : ........................ Name of Parent/Guardian: .............................................................................. Cut Here (Signature of the Candidate)
SEND THE UPPER PART TO JEE OFFICE IIT KANPUR TO COMPLETE YOUR APPLICATION
JEE COPY
IIT-JEE 2012
C24313820
IIT-JEE 2012
Indian Institutes of Technology
Choice - II
401
403
APPLICATION FORM NO :
C24313820
To
From Name :
Swati Kapoor
Address :
485001 07672416026
Mobile :
08109329901
PLEASE INSERT THE APPLICATION FORM IN THE ENVELOPE IN SUCH 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 and parent / guardian's signature. b. Your colour photograph (of size 3.5 cm x 4.5 cm) affixed on application appropriately. c. Attested copy of 10th class certifiate for Date of Birth. d. Attested copy of category certificate if you belong to SC/ST/OBC(NCL). e. Request letter for enlarged font question paper if you have poor vision.
2. Retain a photocopy of the completed application form with you. 3. Send your application form to the IIT as mentioned on the address slip.