INDIAN INSTITUTE OF TECHNOLOGY DELHI

FORM "A" APPLICATION

Personal Details

Name of Student MOHAMMAD ESSA Entry Number 2019CEC2737

Date of Birth 24-03-1994 Gender Male (M)
Blood Group B+ Adhaar Number 479265998759
PAN Number BBTPA7230B Nationality India
Person with No Email
Disability
Mobile No. 8056275491 Full/ Part Time Full-Time
Bank Account No Emergency 9419004681
(SBI,IITD) Contact No.
Emergency Koolipora, Khanyar Srinagar Near Guardian's Farooq Ahmad Puttoo
Address Govt. Girls Higher Secondary School. Name
Status Code FSE (FT Sponsored by Employer)

Correspondence Address Permanent Address

Address Koolipora,Khanyar,Near Govt. Address Koolipora,Khanyar,Near

Girls Higher Secondary Govt. Girls Higher Secondary

Country India Country India

State Jammu and Kashmir State Jammu and Kashmir
City Srinagar City Srinagar

Parent's Personal Details

Father's Name Occupation Aadhaar No. PAN No. Contact Email Office Address
Farooq Ahmad Bussiness 34103602510 BRWPP4727941900468 Naid Kadal
8 K 1 Srinagar

Mother's Name Occupation Aadhaar No. PAN No. Contact Email Office Address
Rafiqa Farooq Home 36690091250 882500256
Maker 6 5
Academic Record

Degree Institute Name Discipline Name Exam Percen score Max

Year tage Score
Higher Secondary JKBOSE Science(PCM) 2013 94.00 470 500
(10+2) or
equivalent
BE/BTech/BArch - SRM University Civil 2017 93.60 9.36 10
Bachelor of Engg. Engineering
/Tech./Arch
Hostel Related Information

First Preference : On-Campus Accommodation

Employment Details

Organization Designation From Period To Period Roles Total Pay

L&T,Chennai Senior Engineer 07-2018 Till Now Execution of a 45000

Pump House
using Slipform,
Execution of a
Control Building
L&T,Chennai Graduate 07-2017 07-2018 Scheduling,Sub- 35000
Engineer Contractor
Trainee Billing,Client
Billing,
Escalation
Billing

I MOHAMMAD ESSA Entry No. 2019CEC2737 hereby declare that the information completed by me on this
form is true and correct to the best of my knowledge. I also undertake that in case the information and
documents submitted by me is/are found to be incorrect, my candidature/admission is liable to be cancelled.

Student Signature