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Student Application Form

Nirma University

INSTITUTE OF TECHNOLOGY
( ACADEMIC YEAR : 2022-23)

BACHELOR OF TECHNOLOGY

All India [ 12th Board Examination from a School Located Outside Gujarat ]

NU Application No : ITNUAI08701

Name : Yash Jangid

Address : 584/28, Shringar Chanwari,
Bihari Ganj,
9 No. Petrol Pump Ajmer Alternate Mobile : 9413223665

RAJASTHAN INDIA 305001

Alternate Email :
sharmagirijesh68@gmail.com
Phone : 8005978900

E-mail : rekhag1780@gmail.com

Birth Date : 05/09/2003

Gender : MALE

SSC / HSC Detail(s)

Board Passing Total Obtained

Qualification Name Location Stream Year Status Marks Marks Percentage

SSC CBSE Within - 2020 - 500.00 424.00 84.80

India

HSC CBSE Within SCIENCE 2022 COMPLETED 500.00 448.00 89.60

India

Qualifying Examination Detail(s)

Exam Name : JEE (Main)-2022

JEE (Main)-2022 Application Number : 220310378206

JEE (Main)-2022 Roll Number (Session 1) : RJ01000675

JEE (Main)-2022 Roll Number (Session 2) : RJ01000675

Program Preference(s)

Branch Name Preference No.

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Branch Name Preference No.

Computer Science & Engineering (CSE) 1

Electronics and Communication Engineering (EC) 2

Electronics and Instrumentation Engineering (EI) 3

Electrical Engineering (EE) 4

Civil Engineering (CL) 5

Mechanical Engineering (ME) 6

Chemical Engineering (CH) 7

Candidate Document(s)

Document Name

Candidate's Photo (Passport Size)

Equivalence Certificate from school authority (In case, Letter Grades/ Performance Index or Graded Point Av

HSC (12th Std.) Marksheet

JEE (Main) 2022 Admit Card (Session-I)

JEE (Main) 2022 Admit Card (Session-II)

JEE (Main) 2022 Application Confirmation Page

JEE (Main) 2022 Final Score Card

School Leaving / Transfer Certificate

SSC (10th Std.) Marksheet

Payment Detail(s) :

Payment Payment Payment

Date Bank Name Amount Mode Status Transaction Ref no

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Payment Payment Payment

Date Bank Name Amount Mode Status Transaction Ref no

09/Aug/2022 UNIFIED PAYMENTS 1416.00 UPI SUCCESS PUUPIU12447038704

INTERFACE

I fully understand that filling the form does not guarantee admission to the said programme. For procedures for
the admission go through the academic regulation of the said programme available on the website.

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Student Signature

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