Visvesvaraya National Institute of

Technology, Nagpur

Serial No :  
Date of Reporting :  
Branch Code :  
Admission Form for B Tech / B Arch / M Tech / M Sc /PHD program
[For Office use only]

Section / Class Roll

ID   Enrollment Number    
Number / Batch

[ This form along with relevant testimonials be submitted to admission center of VNIT at the time of Institution reporting as per schedule of
admission ]
Date : 24/06/2019
Registration No. : 201906668
SEAT ALLOTMENT DETAILS :
Programm of Admission : Master of Technology
Branch Alloted : M.Tech. IN STRUCTURAL ENGG.
Round of Allotment : 4
Seat Alloted Through : GATE

Reference No. :
All India Rank (AIR) GATE /
20407          GATE / JAM Score  352          Marks   28.36          
JAM
Gate Registration Number CE19S81406400          Gate Paper Code  CE          
JEE / GATE Roll No CE19S81406400
Allotment Quota ALL INDIA
State of Eligibility TELANGANA
State of Domicile TELANGANA
Allotment Category SC
Candidate Category SC
Name of Counselling Center CON28
PERSONAL DETAILS :
Name of the Student : [The candidates must write the name in the order as appeared / mentioned in 12 th / Qualifying Mark-Sheet ]

Name in English Script PRAVEEN MYADAPALLI

Name in Hindi Script  
Gender :  Male                           Blood Group :  A RH+   Date of Birth :  27/08/1997
Mobile No :  9849953727  Email Id :  mpraveenpaul.321@gmail.com
Nationality :  INDIAN  Urban / Rural:  Urban
Aadhaar No. :  741289901823
Hostel Required:  Yes
Parent Name :

Father's Name Shri  ASHOK MYADAPALLI

Mother's Name Smt.  PADMA MYADAPALLI
Parent Address :

Present Address of Parent H no 7-40 anand nagar colony.pastapur x road zahirabad

City-  Zahirabad  Dist. :    State   Telangana  Country   India
 PIN-  502318   Ph. No.-  6302005442   Mob  7893901197  
mpraveenpaul.4321@gmail.com

Permanent Address (Write if
different from Present Address)
Name & Addreess of Local
Guardian (Please Ignore if not
available)
City-    Dist. :    State     Country   
PIN-     Ph. No.-     Mob    
mpraveenpaul.4321@gmail.com
City-    Dist. :    State   
PIN-     Ph. No.-     Mob    

Parent Occupation :
Father's Occupation & Details Agriculture
Agriculture
H no 7-40 anand nagar colony
City-  Zahirabad  Dist. :  Zahirabad  State   Telangana
PIN-  502318   Ph. No.-  9849953727   Mob  6302005442  
mpraveenpaul.321@gmail.com
Mother's Occupation Details
City-    Dist. :    State   
PIN-     Ph. No.-     Mob    
Father's Annal Income 100000
Mother's Annal Income 0
Relative Name & Contact No. (1) Paul dhinakaran
9959294717
Relative Name & Contact No. (2) Raghu
8099888243
Qualifying Examination Details
For B Tech/B Arch Admission:

Year of Passing 12th Year of Passing 10th

Board from which passed Board from which passed
Name of the School/College Name of the School/College
Name of City/District Name of City/District
Examination Roll No. Examination Roll No.
Marks Obtained Marks Obtained
Total Marks Total Marks
For M Tech/M Sc/PHD Admission:
Degree and Branch -   
Year of Passing
University Name
College Name
City/District
Examination Roll
No.
Marks obtained
or CPI/CGPA
Total Marks
Remarks

Semester Year/Semester Year Max

CGPA SGPA Marks
No. Pattern No. Marks

 
Bank A/c No.
(Please do not mention parent a/c details)

A/c Holder :
Bank A/c No. :
Bank Name :
Branch Code :
Branch Address:      
MICR Code:    IFSC Code  
 

Declaration by the Candidate

I, hereby solemnly declare that the information furnished above is true to the best of my knowledge and belief. If any information furnished by me is
found incorrect, I am liable for disciplinary action and all the fees deposited by me shall be forfeited. I also declare that I will undergo such punishment
as may be imposed upon me by the Authorities for errors and / or omissions including suppression of facts etc, if any.

I hereby give an undertaking -

i. that I understand that I will be bound by institute rules in force and amendments if any in the future in regard to academic rules and fees.

ii. that during the program duration, I will not indulge in any undesired activity and shall maintain highest standards of discipline.

iii. that I will not leave the program midway without prior permission of the institute and will be governed by the rules and regulations of the institute in
force from time to time.

iv. that I will keep my parents always informed about my academic progress.

v. that I will maintain regular attendance in the course in which I am registered.

vi. that I will not claim for appearing in the major test / examination of the course/s in which my attendance is less than prescribed.

vii. that I will make payment of the requisite fee between scheduled period as notified during every semester session, failing which my registration
shall automatically stand cancelled.

viii. that the rules regarding registration / examination / fees / conduct and discipline, in force and amendment if any in the future are acceptable to
me/ shall be binding on to me.

ix. that I understand that maintaining the discipline and code of conduct is essential on campus and failure in compliance will result in disciplinary
action against me and institute decision shall be final and binding upon me.

x. that ragging in any form is strictly prohibited and punishable under the law by the Govt. of India. If I am found involved / indulged in any such
activity, I will have to face disciplinary as per provision of the law and institute rules.

xi. that I understand that institute has banned use of vehicles on campus.

xii. that I promise to submit the documents not submitted within the stipulated time else my admission shall stand cancelled.

(Signature of the Student with Name)

Date

I endorse hereby the declaration given by my ward and promise to abide by above.

(Signature of Parent with Name)

Date

 
Fees Payment Details :
For B Tech / B Arch ( enclose copy of payment receipt)
SN Name of Bank & Branch DD No. Date Amount (Rs.)
i) Counselling centre-
A
ii) At VNIT at the time of Institute Reporting after   4  Round of Allotment
B
Total Amount (A + B)

For M Tech / M Sc / PHD ( enclose copy of payment receipt )

SN Name of Bank & Branch DD No. Date Amount (Rs.)
i) Paid at the time of Admission Round (A) and Institute Reporting (B)
A
B
Total Amount (A + B) 0

Enclosures : (√    Tick the applicable OR × not applicable)

(Instruction - Self attested Xerox copies of following documents in the order mentioned below should be stapled with above admission form be kept
ready at the time of reporting. All original documents should also be arranged in same order for verification. )

1) Seat Allotment Letter × 6) Caste certificate(if Applicable) ×

2) JEE Score Card (for B Tech / B Arch)GATE Score 7) Caste validity (in case of caste certificate issued by
× ×
card (For M Tech)JAM score card for M. Sc. Maharashtra Govt. )
3) Photo ID Proof × 8) Non-Creamy Layer certificate for OBC category ×
4) 10th Std. Passing Certificate (For date of birth
× 9) Certificate for Person with Disabilities(PWD) ×
proof)
5) 12th Std Mark-sheet / Qualifying examination (For
× 10) Transfer/Migration Certificate ×
M Tech)
11) Sponsorship cum experience certificate (For
    ×
candidates alloted seat under sponsored seats
(Enclosures 1 to 5 for all and 6 to 8 for reserved category )

Details of documents not submitted - 1) ........................................................................... 2) ............................................................................

3) ............................................................................ 4) ............................................................................ 5) ............................................................................

( Signature of the Student with Name )

For office use -

Section Class Roll No Batch

 

Date ............................. Verifying official sign .............................