ENGINEERING AND

TECHNOLOGY- UG

APPLICATION NO: NMIT2024/3375

Course Details

Program UG Course BE in Computer Science

and Engineering

Name And Course Preferences

First Name Ram Last Name Ram

Email raam.pragada@gmail.com Mobile Number 916302737988

Preference 2 Preference 3

Personal Details

Date of Birth Blood Group

Gender Others Category Please specify other

category

Caste Religion

Nationality Mother Tongue Please specify other

mother tongue

Alternate Mobile Number Alternate Email Id

Passport Number Passport Expiry Date

Visa Number Visa Expiry Date

Are you physically

challenged?

Applying Category

Reference Number

Permanent Address Details

Country Domestic (Indian State

Resident)
City Address

Pincode

Postal Address Details

Country Domestic (Indian State

Resident)

City Address

Pincode

Guardian Details

Father’s Details Mother’s Details Guardian’s Details

Name

Mobile Number

Email Address

Occupation

Annual income

Organization

Guardian Relation

Educational Details

Xth Class (10th) XIIth Class (12th)

Board

Institute Name

Year of Completion

CGPA / Grade / Percentage

12th/Equivalent Exam Details

Extra Curricular Activity And Sport Details

Level of Participation Position

Event Name

Level of Participation Level of Participation Position

Event Name
Qualification Exam Details

Documents

10th/Equivalent Aadhar Card/ Driving

Marksheet License

12th/Equivalent
Marksheet

Declaration:

I certify that the information provided in this application form is accurate and complete to the best of my knowledge.
In the event of any information provided by me is found incorrect or misleading, my candidature shall be liable to
cancellation by the institute at any time and I shall not be entitled to any refund of the fee paid by me to the institute.