pMjwb tYknIkl XUnIvristI jlMDr PUNJAB TECHNICAL UNIVERSITY, JALANDHAR

PIT HOSHIARPUR
(A constituent institute of PTU)
pMjwb tYknIkl XUnIvristI jlMDr
PUNJAB TECHNICAL UNIVERSITY, JALANDHAR
(Established by Punjab Govt. Act No. 1 of 1997)
Propelling Punjab to A Prosperous Knowledge Society.........
Jalandhar-Kapurthala Highway, Kapurthala-144601. Ph: 01822-662562, Fax: 01822-662573
Application Form for Admission to 2nd Yr. B.Tech. (Lateral Entry) Course
at
PUNJAB INSTITUTE OF TECHNOLOGY, HOSHIARPUR
(A constituent Institute of PTU)
Transit Campus: Pt.J.R.Govt. Polytechnic College,
Jalandhar road Hoshiarpur-146 001
Email:- [email protected], Ph. 01882-252044
Affix Latest
Passport Size
Photograph
SESSION 2014-15
Application ID:…………………….
S. No.: ……..…………
(For Office Use)
(For Office Use)
PERSONAL PARTICULARS
Applying for B.Tech
(Lateral Entry)
1. Name Mr. / Ms._______________________________________________________________________
2. Date of Birth:
D
D
M
M
Y
Y
Y
Y
3. Father’s Name: Sh. ___________________________________________________________________
4. Father’s Occupation (Pls tick):
Govt. Service
Private Service
Business
Agriculture
Others
5. Mother’s Name: Smt. ____________________________________________________________________
6. Mother’s Occupation (Pls tick):
Housewife
Agriculture
Govt. Service
Private Service
Business
Others.
7. Family’s Annual Income in Rupees (`)______________________________________________
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PIT HOSHIARPUR
(A constituent institute of PTU)
8. Permanent Home Address:
________________________________________________________________________________________
________________________________________________________________________________________
_________________________________________________________________________________
9. Address For Correspondence (tick mark
in the box, if same as Permanent Home Address):
__________
________________________________________________________________________________________
________________________________________________________________________________________
10. Student Mobile. No.:__________________________ , Parents Mobile No.:_______________________
11. E-mail id: ___________________________________________________________________________
ADMISSION RELATED INFORMATION
12. Quota, under which admission is required:
(a) State (Pls tick mark
):
Punjab /
Outside Punjab / Fee Waiver
13. Category, under which admission is required (list given below): Sr. No. __________________________
S.No.
Category
1
Scheduled Castes / Scheduled Tribes
2
Backward Classes
3
Border Area
4
Backward Area
5
Sportspersons
6
Children / Grand Children of Freedom Fighters
7
Disabled Persons
8
Defence / Ex-servicemen
9
Para-military Personnel
10
Victims of Terrorist Violence (1984 riots)
11
Tsunami Victims
12
General
13
Fee Waiver (Economically Weaker)
14
Fee Waiver (Handicap)
15
Fee Waiver (Women)
(See Distribution of Seats in Information Brochure)
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PIT HOSHIARPUR
(A constituent institute of PTU)
14. Educational Qualifications (Attach photocopy of the marks sheet/Gazette)
Exam Passed University/Board
School/Institution
Year of Passing
10th
%age of Marks
10+2/ITI
Diploma/B.Sc
FEE RELATED INFORMATION
The fees should be deposited online by registering at www.pitonline.in
15. Amount of Registration Fee: Rs 1000/- for General Category & Others, Rs 500 for SC/ST.
DECLARATION BY THE APPLICANT
I hereby declare that:
a)
The information provided by me in this form is correct to the best of my knowledge and
nothing has been concealed thereof.
b)
I have read the guidelines and instructions for admission and undertake to abide by the rules of
Punjab Institute of Technology, Hoshiarpur.
c)
If any information provided by me found to be incorrect, my admission may be cancelled.
Place: ___________________
__________________________
Signature of the Student
Date: ___________________
__________________________
Signature of the Father/Guardian
------------------------------------------------------------------------------------------------------------------------------(For office use only)
------------------------------------------------------------------------------------------------------------------------------1.
Application ID:____________________________________________________________________
2.
Merit Percentage (Engineering Diploma ):_______________________________________________
3.
Date of Admission:_________________________________________________________________
4.
Enrollment ID/Univ. Roll No..:________________________________________________________
5.
Admitted under Quota:______________________________________________________________
6.
Admitted under Category:____________________________________________________________
Signature of Verifying Officer
Signature of Counseling Officer
(with Date and Stamp)
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PIT HOSHIARPUR
(A constituent institute of PTU)
Note: To confirm the admission, Full Fee of 3rd Semester (Rs 47750/-) is to be paid through
Challan form(Cash/DD) issued by the Institute at HDFC Bank, within three days of seat
allotment.
LIST OF CERTIFICATES DULY ATTESTED TO BE ATTACHED WITH THE APPLICATION
1.
Matriculation Certificate indicating Date of Birth.
2.
Polytechnic Diploma Certificates/DMCs/Provisional Certificate.
2.
Character Certificate from the Institution last attended.
3.
Certificates for availing the benefit of a reserved seat.
4.
Affidavit of the Parents/Guardian to be attested by an Executive Magistrate / Oath Commissioner/
Notary Public in respect of family income (Annexure-2) only for students whose fees has been excempted.
5.
Residence Certificate (If applying for 85% quota), where applicable.
6.
Copy of personal bank account
7.
Four passport size photos (4 nos.)
Application Form, complete in all respect, with all the requisite documents, must be submitted, to the office
of:The Director,
Punjab Institute of Technology,
Transit Campus: Pt. J.R. Polytechnic Govt. College,
Hoshiarpur.
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