PG Course in which the applicant is seeking admission

JNTUH H.T.No. KOMMURI PRA TAP REDD Y INSTITUTE OF TECHNOL OGY PRAT REDDY TECHNOLOGY (Approved by AICTE, New Delhi and Affiliated to JNTUH, Hyderabad)...
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JNTUH H.T.No.

KOMMURI PRA TAP REDD Y INSTITUTE OF TECHNOL OGY PRAT REDDY TECHNOLOGY (Approved by AICTE, New Delhi and Affiliated to JNTUH, Hyderabad) Near Singapore Township, Adjacent to NTPC Power Grid, Ghanpur Gram Panchayat, Ghatkesar, Ranga Reddy Dist. 500 088. e-mail : [email protected], www.kpritech.ac.in Admn.Office : Sai Pragathi Towers, 3-6-519, Opp. KFC, Himayathnagar, Hyderabad. APPLICATION FORM FOR ADMISSION IN TO FIRST YEAR OF B.Tech. / MBA DEGREE COURSE Choose the branch of UG / PG Course in which the applicant is seeking admission

CIVIL

EEE

MECH

ECE

CSE

MBA

Affix your latest passport size photograph

1. Name of the candidate_____________________________________________________ ( As per SSC ) 2. Gender______________ 3. Date of Birth _______________4. Caste_______________ 6. Religion ________________ Annual Income __________________________________ 5. e-mail _______________________________________Mobile No. (Student) ________________________ 7. Programme: B.Tech. / MBA / M.Tech. 8. Course ________________ 9. Level : PG / UG 10. Date of Joining ______________11. Admitted to : Convenor/Management 12. Roll No. ________________ 13. SSC H.T.No. _________________________ 14. SSC % ______________ 15. Year of Pass ___________ 14. Intermediate %_________________ 15. Year of Pass__________ 16. Marks obtained in Groups : Maths : ___________ Physics : _________________

Chemistry : _______________

17. Degree % ______________ 18. % of Marks in Groups : _______________________________________ 16. Reserve Category _________________________ 17. Is Physically Handicapped ____________________ 18. EAMCET / ECET / ICET H.T.No._________________19. EAMCET / ECET / ICET Rank _______________ 20. Sports & Extracurricular activities, if any _____________________________________________________ 21. Identification Marks 1.____________________________________________________________________ 2.___________________________________________________________________ 22. Mother’s Name __________________________23. Father’s Name _______________________________ 25. Occupation & Office Address ______________________________________________________________ _____________________________________________Office Phone No. _____________________________ 24. Telephone No. (Parent) : Land Line (with STD code) ___________________________________________ 26. Parent address for Communication _________________________________________________________ _________________________________________________________________________________________ _________________________________________________Mobile No._______________________________ 26. Remarks _____________________________________________________________________________ _________________________________________________________________________________________ SIGNATURE OF FATHER

SIGNATURE OF MOTHER

DATE :

SIGNATURE OF GUARDIAN SIGNATURE OF THE CANDIDATE

FOR OFFICE USE ONLY Date of admission _____________________ College Roll No. / Hall Ticket No. _______________________ Principal

JNTUH H.T.No.

KOMMURI PRA TAP REDD Y INSTITUTE OF TECHNOL OGY PRAT REDDY TECHNOLOGY (Approved by AICTE, New Delhi and Affiliated to JNTUH, Hyderabad) Near Singapore Township, Adjacent to NTPC Power Grid, Ghanpur Gram Panchayat, Ghatkesar, Ranga Reddy Dist. 500 088. e-mail : [email protected], www.kpritech.ac.in Admn.Office : Sai Pragathi Towers, 3-6-519, Opp. KFC, Himayathnagar, Hyderabad. 1. Name of the candidate_____________________________________________________ ( As per SSC ) 2. Gender______________ 3. Date of Birth _______________4. Caste_______________ 6. Religion ________________ Annual Income __________________________________

Affix your latest passport size photograph

5. e-mail _______________________________________Mobile No. (Student) ________________________ 7. Programme: B.Tech. / MBA / M.Tech. 8. Course ________________ 9. Level : PG / UG 10. Date of Joining ______________11. Admitted to : Convenor/Management 12. Roll No. ________________ 13. SSC H.T.No. _________________________ 14. SSC % ______________ 15. Year of Pass ___________ 14. Intermediate %_________________ 15. Year of Pass__________ 16. Marks obtained in Groups : Maths : ___________ Physics : _________________

Chemistry : _______________

17. Degree % ______________ 18. % of Marks in Groups : _______________________________________ 16. Reserve Category _________________________ 17. Is Physically Handicapped ____________________ 18. EAMCET / ECET / ICET H.T.No._________________19. EAMCET / ECET / ICET Rank _______________ 20. Sports & Extracurricular activities, if any _____________________________________________________ 21. Identification Marks 1.____________________________________________________________________ 2.___________________________________________________________________ 22. Mother’s Name __________________________23. Father’s Name _______________________________ 25. Occupation & Office Address ______________________________________________________________ _____________________________________________Office Phone No. _____________________________ 24. Telephone No. (Parent) : Land Line (with STD code) ___________________________________________ 26. Parent address for Communication _________________________________________________________ _________________________________________________________________________________________ _________________________________________________Mobile No._______________________________ 26. Remarks _____________________________________________________________________________ _________________________________________________________________________________________ SIGNATURE OF FATHER

SIGNATURE OF MOTHER

DATE :

SIGNATURE OF GUARDIAN

SIGNATURE OF THE CANDIDATE

FOR OFFICE USE ONLY Date of admission _____________________ College Roll No. / Hall Ticket No. _______________________ Principal

JNTUH H.T.No.

KOMMURI PRA TAP REDD Y INSTITUTE OF TECHNOL OGY PRAT REDDY TECHNOLOGY (Approved by AICTE, New Delhi and Affiliated to JNTUH, Hyderabad) Near Singapore Township, Adjacent to NTPC Power Grid, Ghanpur Gram Panchayat, Ghatkesar, Ranga Reddy Dist. 500 088. e-mail : [email protected], www.kpritech.ac.in Admn.Office : Sai Pragathi Towers, 3-6-519, Opp. KFC, Himayathnagar, Hyderabad. APPLICATION FORM FOR ADMISSION IN TO FIRST YEAR OF B.Tech. / MBA DEGREE COURSE (B-CATEGORY) Choose the branch of UG / PG Course in which the applicant is seeking admission

CIVIL

EEE

MECH

ECE

CSE

Affix your latest passport size photograph

MBA

1. Name of the candidate_____________________________________________________ ( As per SSC ) 2. Gender______________ 3. Date of Birth _______________4. Caste_______________ 6. Religion ________________ Annual Income __________________________________ 5. e-mail _______________________________________Mobile No. (Student) ________________________ 7. Programme: B.Tech. / MBA / M.Tech. 8. Course ________________ 9. Level : PG / UG 10. Date of Joining ______________11. Admitted to : Convenor/Management 12. Roll No. ________________ 13. SSC H.T.No. _________________________ 14. SSC % ______________ 15. Year of Pass ___________ 14. Intermediate %_________________ 15. Year of Pass__________ 16. Marks obtained in Groups : Maths : ___________ Physics : _________________

Chemistry : _______________

17. Degree % ______________ 18. % of Marks in Groups : _______________________________________ 16. Reserve Category _________________________ 17. Is Physically Handicapped ____________________ 18. EAMCET / ECET / ICET H.T.No._________________19. EAMCET / ECET / ICET Rank _______________ 20. Sports & Extracurricular activities, if any _____________________________________________________ 21. Identification Marks 1.____________________________________________________________________ 2.___________________________________________________________________ 22. Mother’s Name __________________________23. Father’s Name _______________________________ 25. Occupation & Office Address ______________________________________________________________ _____________________________________________Office Phone No. _____________________________ 24. Telephone No. (Parent) : Land Line (with STD code) ___________________________________________ 26. Parent address for Communication _________________________________________________________ _________________________________________________________________________________________ _________________________________________________Mobile No._______________________________ 26. Remarks _____________________________________________________________________________ _________________________________________________________________________________________ SIGNATURE OF FATHER

SIGNATURE OF MOTHER

DATE :

SIGNATURE OF GUARDIAN SIGNATURE OF THE CANDIDATE

FOR OFFICE USE ONLY Date of admission _____________________ College Roll No. / Hall Ticket No. _______________________ Principal

ENCLOSURES CERTIFIED COPIES OF DOCUMENTS TO BE ENCLOSED TO THE APPLICATION 1. EAMCET / ICET Rank card and Hall Ticket if appeared. 2. Qualifying Examination Certificate and Memorandum of Marks / Grade Sheet. 3. Date of Birth Certificate (SSC) 4. Transfer Certificate 5. Bonafide / Conduct Certificate from the institute where he / she last studied. Note : (1). Certified xerox copies of certificates should be attached to the Application form. (2). Original Certificates should be submitted at the time of admission.

DECLARATION BY THE CANDIDATE I, _________________________________________S/o or D/o ________________________________ solemnly declare that, I have passed the qualifying examination from a recognized educational Institution. I have not been debarred / rusticated from any Educational Institution / Board / University. The statement of marks entered by me in this application form pertains only to the qualifying examination passed by me which was held by a recognized Board / Institution. All the statements made in this appalication are true to the best of my knowledge and belief. I clearly understand that if any of the statemtns are subsequently found to be incorrect and untrue, my admission stands cancelled. If i participate in strikes of demonstration within the institutions, I may be suspended from the institution. If I am found responsible for bringing outsiders into the Campus for seeting personal disputes with other students, I may be suspended / expelled from the Institute. If am found in an inebriated condition due to drinking or taking drugs, I may be suspended / expelled Immediately. In all matters between myself and the Institute the orders of the officers concerned will be final and binding on me.

Yours faithfully,

(Signature of the Candidate)

Place : __________________ Date : ___________________

DECLARATION BY THE PARENT / GUARDIAN I, __________________________________________________________________ do solemnly affirm that I undertake to be responsible for the conduct of my Son / Daughter / Ward, Mr. / Miss ___________ __________________________________ and to pay regularly all his / her expenses during his / her stay at the institution. Further, I am prepared to withdraw him / her if he / she act against the rules of the Institute. Signature _________________________________________________ Relationship with the candidate ________________________________

Latest Passport Size photograph of Parent

Address : _________________________________________________ _________________________________________________________ _________________________________________________________ Telephone No. with STD code : ________________________________ Mobile No. : _______________________________________________

Place : ________________________ Date : _________________________ FOR OFFICE USE ONLY A) Whether the candidate appeared for the EAMCET examination B). If yes, indicate the Rank ______________ Hall Ticket No. _______________________ C). Whether the eligibility checked a). Intermediate % > 50 b). Group % > 50 D) Fee particulars : Particulars

1st Year

2nd Year

3rd Year

4th Year

Tuition Fee Yearly Special Fee Transport Fee Book Bank Referred by Mr./Ms ________________________________________________________________ admit Mr. / Miss _____________________________________ Branch allotted _________________ _______________________ Date ____________________ .

OFFICE SUPERINTENDENT

ADMIN OFFICER

PRINCIPAL

SECRETARY