ICE

Applicant Online Registration Form

Your Photo ( 100 x 100 )

Course

Branch

Rank

SEE-UPTU-09

AIEEE

Other Details

% in Class – X	% in Class – XII	PCM %

Seat Category

GEN SC ST OBC OTHER

Applicant Name

Date Of Birth

Date Month Year

Correspondence postal address (IN CAPITALS) (Do not repeat name)


	Phone No	:			Pin Code	:

Permanent Address (IN CAPITALS) (Do not repeat name)


	Phone No	:			Pin Code	:

Family Details

Father’s Name

Profession / Business with Designation

Name of Organization

Mother’s Name

Profession / Business with Designation

Name of Organization

Hostel Required

Yes No

DECLARATION BY THE APPLICANT

All the particulars stated in the application are true to the best of my knowledge and belief. I hereby declare that I have read and understood the rules and regulations of the Institute. I understand that association, whether active or passive with any unlawful organization is forbidden. I assure to abide by the rules, regulations and discipline of the Institute.

I hereby agree to pay any loss or damage to books, apparatus, furniture and any other property belonging to the Institute and its hostel which may be caused due to my carelessness and negligence.

I hereby affirm that the statement made & information furnished in my application for admission is true & correct to the best of my knowledge.

I hereby agree to submit on time all the fees such as tuition fee, examination fees, enrolment fee, hostel fee etc. as & when notified.

I assure you to not to indulge in ragging in any form. I am aware that I will be rusticated from the Institute and criminal proceedings will be initiated against me if I am found indulging in any act of ragging directly or indirectly. My name is to be struck off from the rolls of college in the event of indiscipline activity/ ragging case.

I am aware that smoking and drinking alcohol is strictly prohibited in the campus and hostel and I assure that I shall abide by such restrictions

I am aware that a minimum of 80% of attendance per semester is required before my candidature is cleared by the Institute for any examination, whether conducted by the University or by the Institute. My candidature can be rejected on the basis of my conduct both inside or outside the Institute on account of non participation in mandatory activities of the Institute, or any other account that the authorities may deem fit. I also undertake that I will abide by the all the rules and regulations of the Institute as stated in the General Guidelines for students and notifications issued from time to time.

UNDERTAKING BY THE PARENT / LOCAL GUARDIAN

FATHER/ Local Guardian

(FATHER/ Local Guardian)Paste Passport Size Photograph of parents/ local guardian)

Name

Relationship

Address

Mobile No

Mother/ Local Guardian

(Mother/ Local Guardian)Paste Passport Size Photograph of parents/ local guardian)

Name

Relationship

Address

Mobile No

Security Code

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