Application Form - Calicut University Institute of Engineering

CALICUT UNIVERSITY
INSTITUTE OF ENGINEERING AND TECHNOLOGY
THENHIPALAM. P.O.- 673 636, KERALA.
PH: Office- 0494-2400223,Principal:0494-2407370 www.cuiet.info
APPLICATION FOR ADMISSION TO FIRST YEAR B.TECH DEGREE 2015-16( NRI QUOTA )
Application No.
Name of NRI
Relationship with the applicant
NRI Account No.
Employment Certificate
Passport No.
Residing country
(Photo)
1. NAME IN CAPITALS
(As given in 12th or
equivalent Certificate)
2. Date of Birth in Christian Era
(in words & figures)
3. Sex (write Male or Female)
4. Nationality
5. Religion & Caste
6. (Whether belongs
to SC/ST/OEC/SEBC/General
7. a Name & Address Applicant
7.b Address to which communications are to be sent with
Telephone Number, Mobile, e-mail.
8. Name Occupation & Address with Telephone No. ,Mobile ,E-Mail of
a. Father
b. Mother
9. Qualifying Examinations passed.
(12th Std./Pre- Degree/Diploma)
Name of Examination
School / College
With Address
Board/University
Year of Passing
No. of Attempt Taken
c. Guardian/Relationship
10. Marks obtained in the
qualifying Examination
Subject
Marks secured
Maximum
Marks
Percentage of
Marks
obtained
Mathematics
Physics
Chemistry
Total
11.Details of Xth Examination
Name of
Exam
12. Branches to which
admission is sought
(In order of preference)
1.
Name of the Institute
Name of the Board
Year of
Passing
2.
3.
4.
5.
DECLARATION
I do hereby solemnly affirm
1. that the statements made and information furnished in my application as also in all the enclosures thereto submitted by me are
true.
2. that I have filled the application form myself and if any statement I have made is found to be false or incorrect I shall be liable
to such action as the Institute may deem proper.
3. that I shall strictly abide by the rules and regulations of the Institution and other Instructions from the Head of the Institution
from time to time.
4. that I have neither been involved in any criminal case nor in any case pending against me in a Court of law and I submit myself
to the disciplinary jurisdiction of the Principal and other authorities of the Institute.
5. that I have obtained the minimum marks in the qualifying Examination prescribed by the University of Calicut and the
Commissioner for Entrance Examinations, Government of Kerala for admission to First Year B.Tech/Lateral Entry.
6. that I understand if I am found ineligible for admission to B.Tech at any point of time during the course of study my admission
will be cancelled and I will be removed from the roll of the Institute.
7. that I will not involve in any incident of ragging or unlawful activities and I am aware if I am found involved in any such
incident I will be expelled from the Institution and will be proceeded as per the existing law of the land.
Place :
Date:
Signature of the Applicant.
Declaration by Parent/Guardian
I
………………………………………………………………………….undertake
the
responsibility
of
my
son/daughter/ward…………………………………………………………………………..who is seeking admission to Calicut
University Institute of Engineering & Technology and declare that the facts furnished by him/her are correct and true and if in
future, any fact is found to have been furnished falsely or incorrectly or any information suppressed to secure admission, I shall
withdraw my son/daughter/ward from the course without any claim or consideration for the period of study/stage of the course
he/she has completed. I ………..…………………………………………………. further declare that I fully understand the
consequence of my ward’s involvement in any ragging incident as per the Supreme Court and AICTE directives in this regard.
Place :
Date :
Signature of the Parent/Guardian.