JOINT SEAT ALLOCATION AUTHORITY 2016

IITs, ISM, NITs, IIITs, IIEST and Other-GFTIs for Academic Year 2016-17

Withdrawal Request Letter

Withdrawal Request Date:17/07/2016 14:38:53 PM

Personal Details

JEE(Main) 2015 Roll Number : 74207361

Candidate Name : BHARATHWAJ S
Gender : Male

Category : General

Nationality : INDIAN

Seat Allotment Details

Choice No. : 177

Institute Allocated : National Institute of Technology Karnataka,

Surathkal

Seat Allocated Category : OPEN

Seat Allocated based on : JEE(Main) 2016 Paper-1

Remarks : --

Seat Acceptance Fee Details

State Bank MOPS Reference No. 74207361101

:
Amount : 45000

Repoting Center & Schedule for Withdrawal Cofirmation

Print

JEE(Advanced) 2015 Roll 6064011

Number :

Date of Birth : 30-12-1998

State of Eligibility : KARNATAKA

Person with Disability (PwD) : NO

Round No. : 5

Academic Program Allocated : Mechanical Engineering (4 Years, Bachelor of

Technology)
Allotted Quota : Home State

Rank used for Allotment: 8146

Merchant Reference No. : IG0CGOXXA3

Date : 01/07/2016

Reporting Center : Any designated NIT/IIIT/GFTI only (http://josaa.nic.in/webinfo/Handler/FileHandler.ashx?i=File&ii=60&iii=Y)

Reporting Schedule : On 18 JULY 2016 from 10 AM to 5 PM

Reasons for withdrawal

Expected Course through JoSAA Electrical in any IIT

2016 (Institute, Programme)
Prepare for JEE 2017 No

Account details for fee refund

Account holder name R Latha

Message

Bank Name State Bank of India

The Institute and Programme BITS Pilani Electrical and Electrinics

joining in 2016

Account number 10939713391

IFS Code SBIN0010369

You are required to visit any of the above Reporting Center to confirm withdrawal, failing which your withdrawal request will not be considered.

Declaration

I would like the vacate the allotted seat and withdraw from the seat allocation process of JoSAA 2016. I am aware that I am not eligible for further rounds of seat
allotment.
Signature of the Parent / Guardian
17/7/2016

Note: Please take this signed letter to a reporting center as per above schedule.

Candidate Signature
(BHARATHWAJ S)
17/7/2016