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SLIET

Print Form

Sant Longowal Institute of Engineering and Technology

Tel: 91-8968473523, 91-8968473524 01672-253178,01672-253179

GENERAL DETAILS Form No.: Candidate Name: Father's Name : Mother's Name : Date of Birth : Gender : Category : Nationality: Education Details Admission Sought For : Apply Through : Choice of Course : Stream : Educational Qualification : Contact Details Telephone No.: Mobile No.1: Address Details Mailing Address: Permanent Address: Centre Choice 1st Choice: Patiala 2nd Choice: Chandigarh 3rd Choice: Sangrur H.no 10538/5 Guru Nanak Nagar Jhill Road Tripuri Patiala , Patiala , Patiala , Punjab, 147001 H.no 10538/5 Guru Nanak Nagar Jhill Road Tripuri Patiala , Patiala , Patiala , Punjab , 147001 01752362475 9779497455 Email ID: Mobile No.2: jasrajgill43@gmail.com 9814173056 Degree (SET-III) Direct Entry GROUP A: Electrical/Electronics/Computer Group Electrical & Electronics Engineering Diploma (Other Institute) Result Status : Appearing 56545 JASRAJ SINGH AVTAR SINGH MANJIT KAUR 16 Jul 1993 Male GEN Indian Signature of the Candidate

Paym ent Details Fee Type : Mode of Payment : Registration Cash(PNB) Status Date of Payment : Paid Apr 23 2013 12:00AM

DECLARATION: I hereby declare that all the particulars stated by me in this application form are true to the best of my know ledge and belief. I have read the information brochure of SET-2013 and I shall abide by the terms and conditions therein. Also it is entirely my responsibility, at the time of counselling to prove my eligibilty for admission to Certificate/Diploma/Degree/PG/Ph.D. course in repects of qualification and entitlement for admission against reserve category, if claimed, to the satisfaction of the institute. Further, in the event of suppression or distortion of any fact made in my application form, I understand that my candidature is liable for cancellation. I also understand that the decision of the admission committee of SLIET regarding my admission is final and I shall abide by the decision. Further, if admitted, I promise to abide by the rules and norms of the intitute. Attested Photo of Signature of the Candidate Thum b Im pression Guardian Signature Candidate

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4/24/13

SLIET

Note: Take a print out of this form. After signing and putting your one photograph and thumb impression on this form.Kindly send it through reg. post / speed post addresed to Chairman, SET-2013, SLIET, Longow al (Sangrur), Punjab 148106.

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