* Merit No. ………………

* Institute Roll No….. ………………..

NATIONAL INSTITUTE OF TECHNOLOGY, KURUKSHETRA Application Form for Admission to Four-Semester M.Tech. Degree Course for Academic session 2016-2017

DEPARTMENT** SPECIALISATION (IN ORDER OF PREFERENCE)* (I) -----------------------------------------------------PASSPORT (II) -----------------------------------------------------SIZE (III) -----------------------------------------------------PHOTOGRAPH (IV) -----------------------------------------------------(V) -----------------------------------------------------*Note: The candidate must ensure that the specialization is available in the applicable deptt./school. 1. 2. 3. 4.

5.

6. 7.

8. 9. 10.

Name in Full ………………………………………………………………………… (in block letters) Father’s Name ………………………………………………………………………. (in block letters) Mother’s Name ……………………………………………………………………… (in block letters) Date of Birth (as in Matriculation/higher Secondary Exam.) ………………………….. One thousand nine hundred and ……………………….. ………………………………. (In figures) ………………………………....……… Address (in block letters) ………………………………………………….. ………. ………………………………………………………………………………………. Mobile/Phone No. (if any)………………………., E-mail……………….………… Nationality ……………………. Religion ………………………………………… Do you belong to General/ Scheduled Caste/ Scheduled tribe/OBC/PwD (Tick appropriate) (if yes, attach certificate in support of reservation ) Do you belong to Rural /Urban area ………………………....Rural/Urban Annual Income from all sources Rs. …………………………………… Details of Examination Passed

Exam. Passed (with discipline) BE/B.Sc. (Engg.)/ B.Tech.( AMIE ( M.Sc. (

Year

Roll No. CGPA

Marks Aggre Name of Institute & Obtained/ gate University Max. %age marks Marks

) ) )

*Not to be filled by the candidate **Separate application should be submitted for different courses 1

11.

Have you qualified the GATE? ……………………………… Yes / No If yes, please indicate (Year) (Roll No.) (score) Gate paper code _______, Gate paper discipline ________________, Qualifying Degree discipline ______________________________, Qualifying degree name: B.Tech./BE/AMIE/M.Sc. (tick one)

12. Have you taken admission in any institute/discipline on the basis of GATE? Yes / No If yes, give particulars. Institute ……………………………………………………………………………………………….. Year …………………………… Discipline …………………………………………………………. Roll No. ………………………..Amount of Scholarship drawn …………………………………….. 13. Have you ever been disqualified or debarred from appearing in any examination conducted by a University/ Board? Yes / No If yes, give particulars:……………………………………………………………………….. 14. Fee Receipt./DD No. & Date…………………………………………………………………….. DECLARATION BY THE CANDIDATE It is declared that all the entries made in this form are correct. I further declare that I fulfill the minimum eligibility conditions laid down for admission. In case of detection of any false entry, especially in respect of degree examination/experience/sponsoring certificate, my admission may be treated as cancelled any time during the course of my study and I will have no claim what-so-ever.

Date …………………

Signature of the Applicant DECLARATION BY THE FATHER/GUARDIAN

I certify that my son/daughter/ward ……………………………………….. submits the application with my knowledge and consent and that I hold myself responsible for his good conduct and for his maintenance and payment of fees during the period he/she is on the Institute Rolls. Date ……………………

Signature of Father/Guardian

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Date of receipt _______________

Regn. No. _______________

(Not to be filled in by the candidate) NATIONAL INSTITUTE OF TECHNOLOGY, KURUKSHETRA ABSTRACT FORM (2016-2017) (To be filled in for all the courses) Applied for Admission to (tick (™) the box applicable)

(i)

Direct Admission under Sponsored Category

(ii)

M. Tech. Degree Course In Deptt./School

Civil

Electrical

Mechanical

Electronics

Computer

School of VLSI Design & Embedded Systems

Physics

School of Renewal Energy & Efficiency

School of Biomedical Engg. School of Material Science and Nanotechnology

Chemistry (iv) Reservation Category GEN

SC

ST

OBC

PwD

1.

Tick (™) the box whichever is applicable. Name in full (in block letters) * _________________________________________

2.

Father’s name (in block letters) * ________________________________________

3.

Date of birth (in words) ** ____________________________________________ One thousand nine hundred and _________________________________________ (in figures) _________________________________________________________

4.

Address for Correspondence ___________________________________________ ________________________________________________ Telephone:____________ Fax:_________E-mail:___________________Mobile No: __________ 5. Aggregate marks of all semesters OR CGPA in qualifying degree_______________

* As in qualifying examination * As in Matriculation Certificate

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LIST OF ENCLOSURES a) B.E. /B.Tech/ M.Sc. Examination Detailed Marks Yes/No b) Character Certificate from Head of Institution last attended Yes/No c) Migration Certificate Yes/No d) Matriculation & Higher Secondary Exam Yes/No. e) SC/ST/OBC Certificate Yes/No f) Sponsorship Certificate /No Objection Certificate Yes/No. g) Photocopies of (i) PF Account No. (ii) ESI from Sponsoring Firm(iii) Last Pay Certificate, (iv) Certificate that sponsoring company is registered under Companies Act-1956. h) Bank Draft of Rs. 1000/- in favor of Director, NIT Kurukshetra payable at SBI Kurukshetra. i) Photo Identity proof as per GOI norms

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Annexure-V SPONSORSHIP CERTIFICATE Certified that Mr./Ms. …………………………………………………………S/o/D/o Shri………………………………. Working as …………………………………… in the department of ………………………………………………………………… from (date) ………………… is a permanent employee of this department/ organization. His/Her name is hereby sponsored for 4-Semester M. Tech. Degree Course. He/She fulfills the minimum eligibility conditions laid down for admission to this course. He/She will be relieved for the said course on the production of Admission Letter. It is further certified that no enquiry is pending against him/her and he/she will be relieved to join the course, if selected. He/She will be absorbed in our Organisation/ Deptt. after the completion of the course. Date ……………………… No. ………………………

Signature of the sponsoring Authority with Stamp

NO OBJECTION CERTIFICATE For Non- sponsored but in service candidates Certified that Mr/Ms. ______________________ S/o/D/o Shri __________________ working as __________________ in the department of ______________________________ from (date) _______________________ is a permanent employee of this Department/ Organization. We have no objection to his/her joining the M.Tech. Degree Course. Date ……………………… No. ………………………

Signature of the sponsoring Authority with Stamp

ADDITIONAL CERTIFICATE IN CASE OF CANDIDATE SPONSORED BY ORGANISATIONS OTHER THAN THE STATE GOVERNMENT OF INDIA

Name of the Candidate ……………………………………………………………... Status: Permanent / Temporary …………………………………………………….. Name of Sponsoring Organisation …………………………………………………. *Regn. No. under the Indian Companies act, 1956 .….…………………………….. Annual Turn-over (Rs.)…………………………..………………………………….. Total Manpower Employed (on regular basis) ….…………………………………... No. of Diploma Holders Employed (on regular basis) …………………………….... No. of Engineering Graduates Employed (on regular basis)………………………… **Will the applicant be retaining lien? …………………………………………….... P.F.A/c No. of the Applicant …………………….………………………………….. E.S.I. Regn. No. of the Applicant …………………………………………………… Certified that Mr/Ms._________________________________ will be absorbed in our organization/Deptt. after the completion of the course. Date ………………………. Signature of the Sponsoring No. ………………………. Authority with stamp --------------------------------------------------------------------------------------------------------------------------* Enclose an attested copy of this certificate showing Registration number under Indian Companies act, 1956. ** If NOT, the candidate will not be considered for admission. 5