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JKC Student Registration Form (BTech) 2012-13 PDF
JKC Student Registration Form (BTech) 2012-13 PDF
Tech
Please Use Block Letters to fill application, please read the instructions before fill the form
Personal Details
Name: Gender: Date of Birth: Male
D D
Female
M M Y Y Y Y
Please affix your recent passport size photo graph, Attestation required, do not staple the photo graph
Religion:
Category: Please tick on top of appropriate one [BCA / BCB / BCC / BC-D / BC-E / SC / ST / OC] EAMCET RANK: Father / Mother Name, Profession: Family Annual Income: Rs.
Institution Details
Name of the Institution: Affiliated University: Passing out Year: 2013 2014 Branch: 2015
Please affix your recent passport size photo graph, Attestation required, do not staple the photo graph
A.P. Society for Knowledge Networks Jawahar Knowledge Center Student Registration Form B.E / B.Tech
Academic Details
Total Marks
Marks Obtained
st
nd rd
Semester
Semester
Yes
Registration Fee Details (Each student is supposed to draw an individual DD of Rs. 3000/- in favor of Institute for Electronic Governance payable at Hyderabad and attach the same along with the application form) Amount: Rs. Drawn Bank & Branch: DD Number: Drawn Date:
D D M M Y Y Y Y
Note: A nominal Registration fee for the SC and ST category students of Rs. 500/- for the Engineering students, copy of their caste certificate is to be attached along with the Registration Form(without authentic Caste certificate application will not be accepted).
Declaration
I declare that all the above details are true to the best of my knowledge. If the details are found to be incorrect at any stage, I am liable to any action taken by JKC. I understand that upon my selection to any company through JKC, I have to pay Rs. 10000/towards special fee to JKC. I agree that I have read all the terms & conditions mentioned in the JKC student registration notification and I am accepting all these terms and conditions as decided by the JKC in the interest of the program.
Date: Place:
I Mr./Ms.
hereby declare that I am aware of the JKC program that is conducting for
the benefit of students and I am willing to join my son/daughter/ward into this program.
Date: Place:
A.P. Society for Knowledge Networks Jawahar Knowledge Center Student Registration Form B.E / B.Tech
The details given by the student above are verified and found to be correct. College assures that it will provide all the facilities needed to conduct the JKC training programs and extend all the support for the workshop(s) Date: Place: