Professional Documents
Culture Documents
Registration
Registration
Registration No.
4. Category: SC
5. Gender: FEMALE
6. Nationality: INDIAN
I. PUNE (108)
11. Choice of
Exam Cities: II. NAGPUR (106)
III. MUMBAI (105)
PASTE RECENT
COLOR PHOTOGRAPH
HERE
3.5 cm x 4.5 cm
with the face
covering about
75% of the photo
D15210031
Place : ......................
Date : ........................
Name of Parent/Guardian: ..............................................................................
(Countersigned by Parent/Guardian)
Your Choice of
Examination
Cities
Choice - I
Choice - II
Choice - III
108
106
105
REGISTRATION NO :
D15210031
D15210031
From:
To:
The Chairman
Joint Entrance Examination (Advanced) - 2013
Indian Institute of Technology Bombay
Powai
Mumbai
PIN Code: 400076
Address:
gopikishan nagar
gopikishan nagar
gopikishan nagar
PIN Code: 431203
Landline No: null
Mobile No: 9421474298, 9421474298
Email: pjadhav624@gmail.com
2. Retain a photocopy of the completed registration form with you for future reference.
3. Send your registration form to the IIT as mentioned on the address slip by 20th May 2013.