For office use only

Sr.No.
Branch Allotted…………………

Shri Krishan Institute of Engineering and Technology

Kurukshetra
(Approved by A.I.C.TE & DTE & Affiliated to Kurukshetra University, Kurukshetra)
Application Form for Admission in B.Tech 4 years Degree course
(To be filled by Candidates’ own handwriting)
1. Name in full ………………………………….
2. Father’s Name …………………………………
3. Mother’s Name ………………………………….
4. Date of Birth ………………………………….
5. Nationality ………………………………….
6. Religion ………………………………….
7. Address (Correspondence) ……………………………………………………..
…………………………………………………… ..
……………………………………………………..
Address(Permanent) ………………………………………………………
………………………………………………….......
8. AIEEE/LEET Rank ……………………………………
Branch options
9. Category ……………………………………
1. ……………….

10. General/SC/ST/BC/OBC …………………………………… 2………………..

3………………. .
11. Details of qualifying Examination:
4………………..
(i) Name of Exam ……………………………………………………..
(ii) Institution Name ……………………………………………………..
City/State/UT ……………………………………………………
(iii) Details of Marks obtained in qualifying Exam.:-

Subject Max.Marks Marks Uni./Board Year of Roll No. %age of

obtained Passing marks

Total:
(iv) Passed in first attempt : Yes/No

12. Ever disqualified from studies : Yes/No

If year, give details……………………………………………………………………

13. Demand Draft for Rs.250/- enclosed Yes/No DD No……………..

14. Declaration:
Certified that all the entries made in this form are correct to the best of my knowledge and
belief.

Place:
Date: Signature of Candidate

UNDERTAKING
1. I, hereby, opt and accept my admission to B.Tech …………. Degree course in the
discipline of ……………………….. Shri Krishan Institute of Engineering and Technology,
Kurukshetra, consequent upon my ranking/position…………………. in LEET/AIEEE-
2009. I hereby further affirm, declare and undertake that I shall abide by the rules &
regulations of the Institution & its affiliated university.
2. I clearly understand that my admission is PROVISIONAL and is subject to the rules and
regulations of this college and its affiliated university.
3. I understand that admission is being offered to me on the basis of the information furnished
by me. In case any information/particulars are found false/wrong, my admission shall stand
cancelled and I shall have no claim whatsoever in respect of my admission and fees etc.
deposited
4. I have accepted the admission at my own risk & responsibility subject to the confirmation
of my admission by the concerned university. If at any stage, I am declared or found
ineligible under the rules, I shall have no claim for it any my admission shall stand
automatically cancelled and ab-initio, in consequence thereof.
5. I also further agree- that the institute shall not be liable in any manner for any consequential
effect financial or otherwise, for any illegality/irregularity by the admission Authority at the
time of my admission.
6. I have gone through all the rules & regulations given in college prospectus and undertake to
abide by the same.

Signature of the Parent/Guardian Signature of the Candidate

_________________________________________________________________________
For office use:

Admitted/Not Admitted Remarks, if any………………………………………

Signature of the Convener