Application No. BIO/JIIT/2011………….

JAYPEE INSTITUTE OF INFORMATION TECHNOLOGY

(Declared Deemed to be University u/s 3 of the UGC Act, 1956)
A -10, Sector - 62, Noida - 201307 (U.P.)
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APPLICATION FORM - 2011 Passport Photo
(For Admission Through Biology/Biotechnology at 10+2 Level or Equivalent)
For B. Tech in Biotechnology(BT), 5 yr Dual Degree B.Tech-M.Tech (Biotechnology) [DD-BT]

PLEASE FILL ALL DETAILS IN CAPITAL LETTERS ONLY

1. Name of Candidate

2. Father’s Name

3. Mother’s Name

4. Date of Birth (DD/MM/YY) 5. Nationality

6. Gender (M/F) 7. Category (Tick ) Gen SC ST OBC

8. Year of Qualifying Examination (10+2) (Passed 10+2 or its equivalent exam not before year 2009)

9. Roll No. in 10+2 (To track your application on website)

10. Score in (Please attach photocopy of marksheet of 10+2) Max. Marks Marks Obtained 11. Priority of Program
Biology/Biotechnology (Compulsory) BT
Physics (Compulsory) DD-BT
Other 1*
Other 2*
Total
* Out of Computer Science, English, Chemistry& Maths (any other subject will not accepted)

12. Current Correspondence address

State Code
District (See list on Reverse)
PIN Code

13. Permanent Home address

State Code
District (See list on Reverse)
PIN Code

14. Contact Details:

Mobile No. Land Line No.
E-mail ID
15. Demand Draft Details: (Not applicable in case form is purchased on payment on cash or by post from Institutional Counter)
DD No. Dated Amount (Rs.)
Bank

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16. Declaration by the Student:
1. I, hereby declare that all the particulars stated in this application form are true to the best of my knowledge and belief. I have
read the Information Brochure and the Admission procedure and I shall abide by them. In the event of suppression or
distortion of any fact like date of birth, nationality, category, qualification etc. made in my application form, I understand that
I will be denied the opportunity to be admitted to JIIT and if already admitted, my admission would stand cancelled. I also
understand that the decision of JIIT regarding my admission will be final and binding to me.
2. I am aware of Universities approach toward ragging and the punishment to which I am liable if found guilty of ragging.

SIGNATURE OF PARENT SIGNATURE OF CANDIDATE

CODES FOR THE STATES

CODE STATE
01 ANDHRA PRADESH
02 ARUNACHAL PRADESH
03 ASSAM
04 BIHAR
05 CHHATTISGARH
06 GOA
07 GUJARAT
08 HARYANA
09 HIMACHAL PRADESH
10 JAMMU AND KASHMIR
11 JHARKHAND
12 KARNATAKA
13 KERALA
14 MADHYA PRADESH
15 MAHARASHTRA
16 MANIPUR
17 MEGHALAYA
18 MIZORAM
19 NAGALAND
20 ORISSA
21 PUNJAB
22 RAJASTHAN
23 SIKKIM
24 TAMIL NADU
25 TRIPURA
26 UTTAR PRADESH
27 UTTARAKHAND
28 WEST BENGAL

UNION TERRITORIES:
29 ANDAMAN AND NICOBAR ISLANDS
30 CHANDIGARH
31 DADRA AND NAGAR HAVELI
32 DAMAN AND DIU
33 LAKSHADWEEP
34 NCR (DELHI, GURGAON, FARIDABAD, GHAZIABAD, NOIDA, GR. NOIDA)
35 PUDUCHERRY