Provisional Admission Registration Form UG I Year (Autumn 2021-22)

Personal Details :

Enrollment No. 21115072

Name KASSAMKUTTIYIL HARSHIL SAJAN

Program B.Tech. (Electrical Engineering)

Year/Semester First Year - 1st Sem (Autumn)

Department Electrical Engineering
Date of Birth 23-September-2003 Nationality INDIAN
State of Domicile GUJARAT Religion CHRISTIANITY
Belongs to Minority Yes Name of Minority CHRISTIANITY
Person with Disabilty False Disabilty Type
Marital Status Unmarried Category GEN
Gender Male Blood Group A+
Aadhar Card No. 318859395084

JEE (Advanced) 2021 Details:

Exam Qualified JEE (ADVANCED) 2021

Rank 1993
Category Rank 0

Student's Bank Details:

Bank Account No. 006401023279 Bank Name ICICI BANK

Branch DRIVEIN RD IFSC Code ICIC0000064

 Provisional Admission Registration Form UG I Year (Autumn 2021-22)

Contact Details
:
Permanent B-23 SUR SAGAR Correspondance B-23 SUR SAGAR
Address TOWERS, SATTADHAR, Address TOWERS, SATTADHAR,
GHATLODIA, GHATLODIA,
AHMEDABAD, NA, AHMEDABAD, NA,
City AHMEDABAD CITY City AHMEDABAD CITY
GUJARAT, 380061 GUJARAT, 380061
Country INDIA State GUJARAT
Pincode 380061 Country INDIA
State INDIA Pincode 380061
Mobile No. 7984368705
IITR Email ID k_hsajan@ee.iitr.ac.in
Personal Email ID harshilsajan@gmail.com

Parents' Details
:
Father's Name SAJAN K.O JOSEPH Mother's Name SUMY SAJAN

Father's Contact No. 9825096229 Mother's Contact No. 9898195523

Father's Occupation CURRENTLY NOT EMPLOYED Mother's Occupation GOVT SERVICE
Father's Income Not Applicable Mother's Income Above 9,00,000
Parent Email ID sajankojoseph@gmail.com

Local Guardian Details :

Name SHREYAS DOBHAL Contact No 7881127805

Address 345 OLD DALANWALA Pincode 248001
GURUDWARA ROAD
Email ID DEHRADUN
shreyasdobhal@gmail.com
 Provisional Admission Registration Form UG I Year (Autumn 2021-22)

Self Declaration:
1. I KASSAMKUTTIYIL HARSHIL SAJAN S/o / D/o SAJAN K.O JOSEPH R/o B-23 SUR SAGAR
TOWERS, SATTADHAR, GHATLODIA, AHMEDABAD, NA, GUJARAT, 380061, AHMEDABAD CITY,
INDIA hereby declare that all duties/facts mentioned in the form are correct.
2. I understand that the status of my admission registration towards UG -I year (2021-22) is provisional
and confirmation is subject to the submission of manadatory documents as per schedule and verification
with the original documents by the Institute.
3. I understand that the Institute reserves the right to cancel my admission offer and
admission-registration if I fail to submit the mandatory documents as per schedule or pass the
verification process or found ineligible at any stage. I also declare that I will abide by the rules and
regulations of IIT Roorkee.

******************

Academic Registration Details

:
Registration Status Registration Done Date of Registration 25-Nov-2021 10:17 am
Session 2021-22 Semester First Year - 1st Sem (Autumn)