6/29/2021 BITSAT 2021 Application Form :: Bits, Pilani

Print
Birla Institute of Technology & Sciences, Pilani
BITSAT-2021
ONLINE APPLICATION FORM

Application Number: 21223518

Personal Details :

Full Name : AMULYA JAISWAL

Gender : MALE

Date of Birth : 06-FEB-2003

Father's Name : JAGDISH PRASAD JAISWAL
Mother's Name : VEENA JAISWAL

Father's Mobile No : 9415077982

Nationality : INDIAN

Email-Id : jaiswalsamrata12@gmail.com
Address : 17/19,KURSWAN
THE MALL

City : KANPUR - 208001

State : UTTAR PRADESH

Land line no. : 05124000205

Mobile No. : 7607364377

Academic Details :
Name of the Institution
Examination
Name of Examination
Board
: DR VIRENDRA SWARUP PUBLIC SCHOOL CANTT,KANPUR
: 12th CLASS (or) ITS EQUIVALENT
: COUNCIL FOR THE INDIAN SCHOOL CERTIFICATE EXAMINATION -
INDIAN SCHOOL CERTIFICATE (YEAR-12) EXAMINATION [ISCT]

Year of Passing : 2021

Subject selected for Part
IV of BITSAT
Test Center Preferences
: MATHEMATICS
: Preference 1 : KANPUR
Preference 2 : LUCKNOW
Preference 3 : AGRA

Payment Details:- Application fee paid through online mode (PayTM) with the below particulars.
Transaction Number Transaction Date Transaction Amount (INR)
20210629111212800110168977817961119 29-06-2021 3400.00

Declaration: I hereby declare that all particulars given in this application form are true to the best of my
knowledge and belief. I have read and understood all the instructions for appearing in BITSAT-2021. I shall abide
by the terms and conditions of BITSAT-2021.

* Do not post this application to BITS, Pilani.

https://bitsat.cbexams.com/bitsatapply2021/printAppform.aspx?skey=BITS1624979981550FDINTERNATIONAL1624979981550APPLICATION16249799815… 1/1