Chaudhary Charan Singh University, Meerut (SCRIET)

Registration Form for Admission in University Campus-2021

1. Course Applied For : B.Tech. (1st Year)

Branch Names : Agricultural Engineering, Information Technology Engineering and
Chemical Engineering
Provisionally Allotted Branch : Agricultural Engineering Form No:22260931
2. Name of the Candidate : HARSH VEER CHAUDHARY
3. Father`s Name : NAGENDRA CHAUDHARY
4. Mother`s Name : SANGEETA CHAUDHARY
5. Date of Birth : 23/12/2003 6. Gender : Male 7. Religion : Hindu
8. Kashmiri Residents : No 9. Nationality : INDIAN
10. Category : OBC 11. Minority : No 12. Blood Group : O+
13. Physically Handicapped : No
14. State from where Intermediate/+2 Passed : U.P
15. Do you have Domicile Cert. of U.P. State : Yes 16. Marital Status : Unmarried
17. Permanent Address : WARD NO 13 B BLOCK HASTINAPUR, MEERUT, Meerut, Uttar Pradesh, Pin : 250404
18. Correspondence Address : WARD NO 13 B BLOCK HASTINAPUR, MEERUT, Meerut, Uttar Pradesh, Pin :
250404
Signature of Candidate
19. Mobile No. (Candidate) : 7505815606 (Parent) : 7417010010 (Alternate) :
20. Aadhaar No. : 21. Email ID : SAINIADITYA86069@GMAIL.COM
22. NAD ID & Portal : []

23. Description of Examination:

Examination Year Name of the School/College Name Roll No. Subject Offered Mrks Max. Per.(%)
Board/University obt. Mrks
High School 2019 CBSE NEW BLOOMS PUBLIC 5421417 ENGLISH HINDI 448 500 89.60
SCHOOL HASTINAPUR MATHS SCIENCE S
MEERUT UP SCIENCE
Intermediate 2021 CBSE NEW BLOOMS PUBLIC 21699497 Including Physics, 445 500 89.00
SCHOOL HASTINAPUR Maths and Chemistry
MEERUT UP
Graduation
Post Graduation
24. Reservation Claimed : Yes 25. Annual Income of the Parents : 72000
26. Do you have a smartphone / laptop with a front camera for your own use ? : Yes
27. Do you have a steady, stable and fast internet facility? : Yes
28. Do you have speakers / earphones / microphones or necessary equipment for attending online classes?: Yes

29. Checklist (Attached Documents)

Marksheet of High School : Yes Marksheet of Intermediate : Yes Marksheet of Graduation : No
Marksheet of Post Graduation : No Residence/Domicile Certificate : Yes Physically Handicaped Certificate : No
Caste Certificate :Yes
Any other certificate 1. 2.
Detail of Fee Paid
Transaction Date Transaction No. Paid Amount Remark
28/08/2021 CCSU-F21D50E6BB8E34D-1 Rs. 115/- Registration Fee
03/09/2021 CCSU-5F38F12864E48B3-1 Rs. 10000/- Token Money
03/09/2021 CCSU-E4A82165BD9D5F7-1 Rs. 1000/- Admission Process Fee

Declaration
I HARSH VEER CHAUDHARY(22260931) hereby declare that I have read the eligibility conditions very carefully and I undertake the responsibility
of fulfilling eligibility conditions. The entries in the form are correct to the best of my knowledge and belief. If any entry is found to be wrong or false,
my admission may be cancelled at any time. I will pay all dues in accordance with the University rules and regulations and also abide by the rules of
conduct, behavior and studies

Instruction for Candidates

Candidate will be informed by SMS or Email that when to come SCRIET for Admission process. Candidate have to bring their original documents
and photo copies of documents along with this Registration Form at the time of Admission.

Date:___________________

Place:___________________ (Full Signature of the Applicant)

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 Chaudhary Charan Singh University, Meerut (SCRIET)
Registration Form for Admission in University Campus-2021

Affidavit / Declaration by ( HARSH VEER CHAUDHARY )

The deponent named above hereby states, affirms and declares an oath as follows:

That my name is HARSH VEER CHAUDHARY aged 18 Years S/O//D/O NAGENDRA CHAUDHARY resident of WARD NO 13 B BLOCK

WARD NO 13 B BLOCK MEERUT belonging to General/ OBC/ SC/ ST/ EWS category and being the applicant for seeking admission in (B.Tech. 1st

Year ) with Sir Chhotu Ram Institute of Engineering & Technology / Institute of Business Studies / Department of Computer Application, CCS

University Campus, Meerut, I solemnly affirm, state and declare on oath as follows:

1. That the deponent completely understands and concurs that his / her admission in the aforementioned course is purely provisional in nature and

has been sought on the advance payment of Rs.10,000/- other than the processing fees of Rs...................

2. That the deponent undertakes that as his / her admission is provisional in nature, he / she shall not make a claim against any seat in the aforesaid

course against the amount deposited as mentioned in para supra.

3. That the deponent understands and concurs to the facts that his / her admission in the aforesaid course shall only be confirmed on the basis of

merit that shall be declared by the University. Such merit will be declared against the seat(s) lying vacant subsequent to the counseling of UPSEE. The

deponent further undertakes payment of his / her residual fee for the semester / session if the admission of deponent is confirmed.

4. That the deponent understands that in case of no admission or withdrawal of provisional admission the processing fee will not be refunded.

5. That the deponent also undertakes not to apply for any hostel facility until the provisional admission is confirmed and residual fees for the semester /

session is submitted / deposited by the deponent.

6. That the deponent concurs to the fact that the confirmation of his / her admission in the aforesaid course doesn't create his / her right on the hostel

facilities of the University.

7. That the deponent undertakes to abide to the rules and regulations of the University which have been framed for the attainment and continuance of

hostel facilities.

8. That the deponent undertakes that he / she shall not object, in any manner whatsoever, if by any reason the provisional admission of the deponent

is not confirmed by the University or is cancelled by the University.

9. That the contents of Para1 to 7 of this affidavit/ undertaking are true to my personal. Nothing material has been concealed.

Verified at...........................(Place) on this.........................(day) of .......................(Month)........................(Year).

Deponent

24/Nov/2021

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