Degree : B.E.
(IN HINDI) :
2. Father's Name (
(IN HINDI) :
3. Mother's Name (
(IN HINDI) :
RAJASTHAN
4. Date of Birth :
02/03/1997
5. Domicile :
6. Gender :
MALE
7. Res. Category :
8. Category :
GEN
9. Caste Name :
NO
13. Is Working? :
NO
NA
HINDU
17. Email ID :
pratiksingh199@outlook.com
19. Nationality :
INDIAN
NO
NO
21. Address
ENGLISH
22. Medium
Permanent Address
Address of Correspondence
Photo of Candidate
Address :
pratik singh rathore c/o roop singh rathore,
vill.= redi bhurwas, tas.= taranagar, dist.=
churu, raj. (331304)
Address :
pratik singh rathore c/o roop singh rathore,
vill.= redi bhurwas, tas.= taranagar, dist.=
churu, raj. (331304)
District :
District :
Pin :
churu
331304
Pin :
churu
Signature of Candidate
331304
Phone :
Mobile :
7728947425
187922
2133394
2012
1655046
Page 1 of 3
27. Whether you were punished for any offense / unfair means committed by you in the previously attended or the
present institution (If yes, give details ) :
28. Weightages Claimed :
Year
Matriculation
2012
Intermediate
2014
Max
Marks
Percentage/ ExamStream
Grade
Obt.
Marks
0.00
0.00
Subjects
Central Board of
Secondary Edu. 2,
Community Centre,
Shiksha Kendra, Preet
Vihar, Delhi-110 092.
B2
500.00 415.00
83.00%
Board/University
Physics Chemistry
Mathematics
Central Board of
Secondary Edu. 2,
Community Centre,
Shiksha Kendra, Preet
Vihar, Delhi-110 092.
Compulsory subjects
1
--NA--
Preference
NOTE: Mark the number of documents ( Photocopy/Xerox) attached by the Candidate during form submission to the college :
(a)
Xth Marksheet
(d)
(g)
(j)
(m)
(e)
(h)
(k)
(n)
(f) Signature
(i) Certificate for Horz./Reservation Category
(l) Character Certificate
(o) Gap year Certificate
Photograph
Certificate for Kashmiri Migrants.
Transfer Certificate
Income Certificate
Page 2 of 3
Undertaking
1. /
/ |
2. / |
3. / ,
/
/ |
4. / / |
5. / / 100%
/ 75% / |
6. , / / |
7.
|
/
/ | / |
/ / |
Dated :
Signature of Parent's/Guardian
Last Submit Date & Time ( 7/14/2016 1:18:20PM) IST
Student Receipt
Registration No. : J16U723983
Receiver's Signature
B.E.
Page 3 of 3