Application_Form_of_1084663 https://student.nielit.gov.in/CAND/Application.

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National Institute of Electronics and Information Technology

Ministry of Electronics and Information Technology, Government of India

[Registration Wing]
Form for capturing details of Parent's Name & Communication Details
1. Registration Details Date: 13-Jan-2017
Registration Number 1084663
Current Level O Level
2. Address For Communication
Address1 Renuka Nivas
Address2 Po-Peringode
Address3 Via-Koottanad
City Pattambi Taluk District Palakkad
State Kerala Pin Code 679535

DATA TO BE CAPTURED
Please provide the following information
3. Applicant's Personal Details
Name of Candidate Mr. Nair Vineshkumar Parameswaran
Father's Name Mr. P. Parameswaran Nair
Mother's Name Mrs. Renuka
Date of Birth (dd-MMM-yyyy) 10-Oct-1985
4. Contact Details
Phone Number with STD NA
Mobile Number 8301859762
Email Address vinesh.kumar.022@gmail.com
(Please provide your active e-mail ID and mobile number. Kindly note that important data/information pertaining to registration form will be provided to candidates through e-mail/SMS.)
5. Attachment
Attested copies of certificates in support of Father/Mother's or Guardian's Name
6. Declaration
I hereby declare that the above statement and information are correct to the best of my knowledge and belief and I agree and abide by the information above.
I have attached self attested certificates in support of Father/Mother's or Guardian's Name.

................................................
[Signature of the Applicant]

Photograph of the Applicant Signature of the Applicant Left hand thumb impression

This form can also be downloaded from our website www.nielit.in www.nielit.in
Father's and mother's name must be according to 10th qualifying certificate or any certificate issued by any
Government agency.
The certificate will not be issued unless and until this filled in form is received whether by post or submitted
personally at our following address.

National Institute of Electronics and Information Technology

NIELIT Bhawan,Plot No. 3, PSP Pocket, Sector-8, Dwarka,New Delhi-110077

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