GMR INSTITUTE OF TECHNOLOGY, RAJAM.

REGISTRATION FORM
Instructions to use the registrtion !or"
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GMR Institute o! Techno#og$
GMR Naar# Ra$am % &'( )(*#
Sri+a+ulam district#
Andhra Pradesh
TE, : -./0)%(&)&/(# (&)&/'1
FA2 : -./0)%(&)&/)
E%MAI, : mrit!mrit"or
GMR INSTITUTE OF TECHNOLOGY, RAJAM.
REGISTRATION FORM
For O%ce Use On#$ STATE
&HOTO
EAM3ET Ran+ : Nationality
4all Tic+et No" : Reliion
Scrutinised 5y : 3ateory
6ranch
Allotted
: S37ST76373AP7P47GEN
Fee Receipt
No"
: Any Other
8ate :
3on9ener 7
Manaement
)" Name of the 3andidate :6loc+ ,etters; :
<<<<<<<<<<<<<<<<<<<<<<<<<""""""""""""""""
:as per S"S"3" 7 Matriculation;
2. Fathers / Guardians Name and Address:
&IN '
&IN '
E%mail : <<<<<<<<<<<<<<<<<< Tel :O="; <<<<<<<<<<<< :Res";
<<<<<<<<<<
Nearest Rail>ay Station :
<<<<<<<<<<<<<<<<<
'" 6lood Group : <<<<<<<<<<<<<<<<<<
0" Occupation of Parent 7 Guardian : <<<<<<<<<<<"
&" Annual Income <<<<<<" ?" @r5an 7 Rural <<<<<<<<<<<<<<<<<<"
*" 8etails of Institutions >here studied and eAaminations passed:
E("intion
Yer o!
&ssin
g
Institution
Atten)e)
*or) +
Uni,.
Mr-s
O.tine)
/ o!
Mr-
s
C#ss
S.S.C.
Inter"e)ite + 01
." Medium of Instruction :
<<<<<<<<<<<<<<<<<<<<<<<<<<<<<"
/" 8ate of 6irth :
<<<<<<<<<<<<<<<<<<<<<<<<<<<<<"
)-" 3aste<<<<<< Group :
<<<<<<<<<<<<<<<<<<<<<<<<<<<<<"
))" a; 8etails of Scholarship 7 3oncession :
<<<<<<<<<<<<<<<<<<<<<<<<<<<<<"
a>arded last year
5; If so# sanction order No" B amount :
<<<<<<<<<<<<<<<<<<<<<<<<<<<<<"
For )"ission to the *.Tech. course 2 un)er ctegor$ A + *
sanctioned
)(" ,ocal Guardian :if any; :
<<<<<<<<<<<<<<<<<<<<<<<<<<<<<
Cith address and telephone No" :
<<<<<<<<<<<<<<<<<<<<<<<<<<<<<
A)"in. O%cer Signture o!
A33#icnt
4te ' 555555555555
UN4ERTA6INGS TO *E GI7EN *Y THE CAN4I4ATE AN4 HIS+HER &ARENT
Ce#
<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<
<<<<<<" and
:Name of the 3andidate;
<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<
<<<<<<<<<<<
:Name of the Parent 7 Guardian;
:<<"<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<";# $ointly
underta+en to a5ide
:Specify the relationship to the candidate;
and fulDll the follo>in conditions"
<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<"
:Name of the candidate;
)" Ce >ill pay the tuition fees and other fees prescri5ed 5y the Go9ernment of A"P"# ENT@# and
GMRIT# as per the schedule# >ell 5efore the last day of payment of fees"
(" Ce >ill not see+ any facility or concession for payment of tuition fee in installment and >ill remit
the entire tuition fee in the 5einnin of the academic year# 5efore the last day of payment of
fees"
'" In case the candidate discontinues his7 her studies at GMR Institute of Technoloy# Ra$am# for
>hate9er reason it may 5e# >e >ill pay the full amount of the tuition fees that the candidate
>ould ha9e paid# had he7she continued the course up to completion"
0" Ce authoriFe the GMR Institute of Technoloy to conDscate all the oriinal certiDcates su5mitted#
in case >e fail to pay the entire tuition fees for the entire course"
&" Ce >ill not claim for any chane of 5ranch durin the entire period of study of 6"Tech" course at
GMR Institute of Technoloy# Ra$am eAcept >hen 9acancies arise in the )
st
year class due to
drop%outs and the candidate 5ecomes elii5le for chane of 5ranch of the 5asis of the 3o%
ordinator# EAM3ET"
Signture o! &rent + Gur)in ' Signture o! cn)i)te '
Name : Name :
Address :
:); I promise that I >ill conduct myself in an eAemplary manner and shall do all necessary thins to
uphold the prestie and reputation of GMRIT" I >ill not in9ol9e in any stri+es# demonstrations and
in any other unla>ful acti9ities# 5oth inside and outside the 3ampus"
I @nderstand any 9iolation# on my part# of the disciplinary measures prescri5ed 5y the institute
>ill attract imposition of Dnes# suspension and e9en rustication or any other punishment deemed
Dt 5y the authorities# and I shall a5ide 5y decision that >ould 5e ta+en 5y the authorities"
:(; I understand that rain of $unior students is inhuman and punisha5le under la>" I promise that
I >ill not in9ol9e in any form of rain" I clearly understand that any person :may 5e myself;
>ho so e9er is directly or indirectly in9ol9ed in RAGGING is su5$ect to se9ere punishment# can 5e
5oo+ed in a criminal case# and can 5e arrested"
:'; I >ill strictly a5ide 5y all the rules of the Institution"
Signture o! Stu)ent
Name :
6ranch :
Roll No" :
I ensure that my Son7 8auhter >ill not 9iolate any rule prescri5ed 5y Go9t"# @ni9ersity B Institution" Also
I ensure that my Son7 8auhter maintains discipline and >ill 5e reular to the classes B Studies
Signture o! &rent