Application Information

मौलाना आजाद राष्ट्रीय प्रौद्योगिकी संस्थान

Maulana Azad National Institute of Technology

Application
Application No: B.Tech/ B.Arch/ B.Plan/ Dual Degree (B.Tech & M.Tech) Candidate Image Candidate Signature
Apply : Joint Entrance Examination
Session : 2022, Odd
Application Status : Freezed
Apply On: 2022-11-03T20:08:22.986+05:30

Application Information

Personal Information

Name: Ankita Rai Email: ankitarai737@gmail.com PWD Status: No

Father: Santosh Rai Father Occupation: Site Supervisor
Mother Occupation: Housewife Contact No: 7869198947
Date Of Birth: 2004-07-02 Gender: F
Category: OB Address: H.no.7 Shivnagar colony
vidisha road bhanpur bhopal ,Bhopal
,Madhya Pradesh ,India
District: Bhopal Aadhaar: 946212464528
Family Income Category: Income Certificate No:
below_one_lac RS/444/0111/43216/2021
Language of Instruction: Hindi Family Income: 60,000
State Of Eligibilty : Madhya Pradesh Community: Hindus
Educational Information
Mother Name: Anita Rai
Emergency No: 7869198947
Marital Status: S
Police Station: Chhola Road
Passport: NA
Hostler/ Day Scholar: Day Scholar
Admitted Category: OBC-NCl
Mark Of Identity:

SL No. Standard. Qualification Board Discipline Passed Year Marks Full Marks CGPA % Highest

1 10+2 Ankita Rai CBSE PCM 2021 500 448 9.43 89.6 Y

Qualifying Information

SL No. Examination. Exams ID Passed Year. Score Rank Validity(Years)

1 Jee Mains 220310093886 2022 105 60715 2022

Reference Information

SL No. Name. Email Contact No Address Organization

1 NA santoshray742@gmail.com 7869198947 NA NA

Verification Form

Required Documents

1. Copy Of 10 Cerificate 2. Copy Of 10 Marksheet

3. Copy Of 12 Cerificate 4. Copy Of 12 Marksheet

1. Copy Of 10 Cerificate 2. Copy Of 10 Cerificate

3. Copy Of 10 Cerificate 4. Copy Of 10 Cerificate

5. Copy Of Category Cerificate 6. Copy Of Income Cerificate

7. Gap Cerificate 8. Identity Card

9. OBC Cerificate 10. Original Character Character Cerificate

11. Original JEE Admit Card 12. Original JEE Score Card

13. Original Migration Cerificate 14. Original Transfer Cerificate

DECLARATION

Form No. 220101691 Student Name Ankita Rai

Degree Undergraduate Department Chemical Engineering
Course Chemical Engineering

DECLARATION BY THE CANDIDATE

I declare that:

I hereby declare that the information furnished is true, complete and correct to the best of my knowledge and belief. I understand
that in the event of my information being found false or incorrect at any stage, my candidature / application shall be liable to
cancellation / termination without notice or any compensation in lieu thereof.

I understand that the fees can be changed at any point in time by the Institute or Ministry of Education and the same shall be
acceptable to me.

Place: Date: Signature of Candidate:

 DECLARATION BY THE PARENTS/GUARDIAN OF THE CANIDIDATE

I hereby solemnly and sincerely affirm that the statement made and information furnished by my sons / Daughters/ward's
admission form, and also in all the enclosed documents submitted by him/her are true. Should it, however, be found that any
information furnished their in is untrue material particulars, I realize that he/she will forego his/her sit in the institute.

I undertake that I have read and understood the rules and regulations, statutes, ordinances of the institute and my
sons/daughters/wards shall maintain the discipline of the institute and the hostel.

I Understand that the fees are likely to be changed at any point in time by the institute or ministry of education and the same
shall be acceptable to me. The Institute fees are to be increased by @10% per year and it is acceptable to me and I shall pay the
same.

I promised to abide by any decision taken by the director or institute authorities for any breach by my ward during the entire
course. I shall also hold myself responsible and compensative for any damage caused by my ward either in the institute or in the
hostel

I promised to promptly intimate the institute of any change in my address and arrange to receive promptly any communication
from the institute.

Place: Date: Signature of Parent/Guardians: