INDIAN INSTITUTE OF TECHNOLOGY DELHI

FORM "A" APPLICATION

Personal Details

Name of Student VIKRAMJEET MAITRA Entry Number 2022TRY7501

Date of Birth 14-07-1989 Gender Male (M)
Blood Group O+ Adhaar Number 330654902134
PAN Number BFJPM0894R Nationality India
Person with No Email mmaitr@gmail.com
Disability
Mobile No. 9123055806 Full/ Part Time Full-Time
Status Code OPB (Part Time Registration) Date of Joining 06-07-2022

Hostel Dronagiri Room No. Third floor -316

Emergency Emergency 9903382343

Address Contact No.
Bank Details

Account No. 95982010049898

Bank Name Canara Bank

IFSC CNRB0019598

Correspondence Address Permanent Address

Address CA-96, SECTOR1, SALT LAKE Address CA-96, SECTOR1, SALT LAKE
CITY,KOLKATA CITY,KOLKATA

Country India Country India

State West Bengal State West Bengal
City Kolkata City Kolkata

Guradian's Details

Name Mobile Email Office Addess Corres. Perm. Address

 Parent's Personal Details

Father's Name Occupation Aadhaar PAN No. Contact Email Office Address

Mother's Name Occupation Aadhaar PAN No. Contact Email Office Address
Mili Maitra housewife

Academic Record

Employment Details

Organization Designation From Period To Period Roles Total Pay

I VIKRAMJEET MAITRA Entry No. 2022TRY7501 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