B.

TECH APPLICATION FORM 2024 (PHASE-2)

APPLICATION NO :24012025337

Program And Campus Preference

SRMIST, MAIN CAMPUS
Campus Program COMPUTER SCIENCE Specialization BLOCK CHAIN
(KATTANKULATHUR,
Preference 1 Preference 1 AND ENGINEERING Preference 1 TECHNOLOGY
CHENNAI)
Campus SRMIST, RAMAPURAM Program COMPUTER SCIENCE Specialization
BIG DATA ANALYTICS
Preference 2 CAMPUS Preference 2 AND ENGINEERING Preference 2
ARTIFICIAL
Campus SRMIST, VADAPALANI Program COMPUTER SCIENCE Specialization
INTELLIGENCE AND
Preference 3 CAMPUS Preference 3 AND ENGINEERING Preference 3
MACHINE LEARNING

Personal Details
Nationality INDIAN
Category (NRI / PIO / OCI)
OCI/PIO/NRI Number
Have You Studied From India? YES
Student Aadhar No. 610226617312
Full Name (As Per The Qualifying Examination
GARINE SAI AJAY
Certificate)
Mobile No. +91-6300155694
WhatsApp Mobile Number +91-6300155694
Email ID SAIAJAYGARINE@GMAIL.COM
Alternate Email ID KRISHNAVENIGARINE@GMAIL.COM
Date Of Birth 27/12/2005
Gender MALE

Family Details
Parent Details :FATHER
Father Mother Guardian
Title MR
Name GARINE HANUMANTHA RAO
Mobile Number +91-7382621077
Email Address HANUMANTHARAOG@NTPC.CO.IN

Address Details
GA-15 KV MARG ATM CHOWK
Address : Pin Code : 751021
CSPUR
Country Name :INDIA State : ODISHA District : KHORDHA City: BHUBANESWAR

Academic Details
Current Education Qualification Status : 12TH COMPLETED
XII Details : X Details :
Institute Name PRATHIBHA JUNIOR COLLEGE DE PAUL SCHOOL
ANDHRA PRADESH BOARD OF INTERMEDIATE COUNCIL OF INDIAN SCHOOL CERTIFICATE
Board
EDUCATION EXAMINATION (CISCE/ICSE)
Mode of Study REGULAR REGULAR
Marking Scheme PERCENTAGE PERCENTAGE
Percentage / CGPA 85.7 92.66
Year Of Passing 2023 2021
Hall ticket No./Registration No. 2303216538 7482839
Address Of School/College DANAVAIPETA, RAJAMUNDRY -533103 -
NAD ID/Digilocker ID -

Payment Details
Transaction ID 113275838294
Payment Date 04/05/2024
Mode Of Payment

Declaration
I certify that the information submitted by me in support of this application, Is true to the best of my knowledge and belief. I understand that
in the event of any information being found false or incorrect, My admission is liable to be rejected / cancelled at any stage of the program. I
undertake to abide by the disciplinary rules and regulations of the institute.
I hereby declare that I have gone through the eligibility criteria as given in the link below. I am fully aware that, If I do not meet the eligibility
criteria, any provisional admission given to me during the counselling period will be forfeited.
For more information , check - https://www.srmist.edu.in/admission-india/engineering

Applicant Name :GARINE SAI AJAY

Parent Name :GARINE HANUMANTHA RAO

Date :04/05/2024