VIGNAN’S INSTITUTE OF INFORMATION TECHNOLOGY(A):: VISAKHAPATNAM

ECET STUDENT ADMISSION DATA FORM - 2019 BATCH

Date of Admission: 2 0 1 9 Branch:

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ECET (Year / Rank): Category: OC BC SC ST (Put √ in box)

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Adm. No: 1 9 JNTUK Reg. 1 9 L 3 5 A

No :

NAME IN FULL:

Sex: Male Female (Put √ in box) D D M M Y Y Y Y

Recent
Date of Birth as per S.S.C: Photo

Identification 1)
Marks as per
S.S.C 2)

Father’s/ Guardian’s Name_________________________________ Occupation: _____________ Annual Income Rs. ____________

Mother’s Name:_________________________
Mother Tongue: ________________________ Nationality: _______________ Religion________________ Blood Group __________
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In case of SC/ST/BC Scholarship holders Caste Student Aadhar No: __________________________

Permanent Address : Address for Communication :

Pin: Pin:
Phone Nos(s): ___________________________________ Phone Nos(s): __________________________________
ACADEMIC DETAILS:
Regd.No
Name of the Marks Total %
&Year of Medium Name of the School & College Studied Place.
Board Exam. Obtained Marks Marks passing
S.S.C/CBSE/
ICSE %

Diploma %

Languages Known: _____________________________ Hobbies: __________________________________T.C.No.

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Student Email. ID: ______________________________________________________Blood Group: ___________________________

Student’s Undertaking Parent’s Undertaking

I shall be abide by the rules and regulations of the college and also I shall undertake the responsibility of good conduct and behavior of
undertake not to indulge in any activity, which is restricted by the my ward during his/her stay at the college and shall pay all fee and
College. other payments punctually as and when asked by the college

Signature of the student

Signature of the parent
For Office Use : ____________________________________________________________________________________________