NIRMA UNIVERSITY

Sarkhej-Gandhinagar Highway,
Ahmedabad - 382481,
INSTITUTE OF TECHNOLOGY Gujarat - India
APPLICATION FORM : B.Tech.(All India Category-35% Seats) : 2017

Admission : 2017 Nirma Application ID :ITNUAI000216

Program Detail

Program : Bachelor of Technology

Personal Detail

Applicant Name : HEET KETANKUMAR SHAH

Father's name : KETANKUMAR HIMATLAL SHAH Mother's name : JAIMINIBEN KETANKUMAR SHAH

Date of Birth : 25/12/1999 Gender : Male

Nationality : Indian Admission Category : 12th School located in Gujarat

Correspondence Address

13,SHARNAM 5 BUNGLOWS NEAR SATYAM FLATS JODHPUR GAM SATELLITE AHMADABAD GUJRAT INDIA - 380015

Contact Details - Candidate

Phone:-(079)26920133 Moblie:-919879201521 Email ID:-2482.stkabirdin@gmail.com

Contact Details Parent/Guardian

Phone:- Moblie:-919925005515 Email ID:-khshah1204@yahoo.com

Details of Qualification
Board/ Obtained Percentage Admission Year of
Qualification Degree Results Marks/CGPI Total Marks Percentile
University Marks Obtain Year Passing

CENTRAL
BOARD OF
HSC HSC Awaited CGPI - - 04/2017 05/2017 -
SECONDARY
EDUCATION

Semester / Trimester / Year wise Detail

Year Of
Qualification Semester Total Marks Marks Obtained Percentage Merit Marks Awaited
Apper

Program Preference
Branch Code Preference

Mechanical Engineering 1

Information Technology 2

Chemical Engineering 3

Electronics and Communication Engineering 4

Computer Engineering 5

Instrumentation and Control Engineering 6

Electrical Engineering 7

Payment Details
DD No /Bank Transaction ID Payment Mode Transaction Date Drawn Bank Amount

29268882 Online 03:31:13 PM 14/04/2017 350

03:31:30 PM 14/04/2017
 Entrance Exam (JEE(Main) 2017) JEE(Main) 2017
Year of
Application No./Reg. No. Roll No/Seat No. Marks Score Rank Score Valid upto
Exam

70524799 11805444

I certify that the information given above is correct. I understand that if any information is found incorrect, my admission is
liable to be cancelled.
Applicant Signature

03:31:30 PM 14/04/2017