Anda di halaman 1dari 1

Admissions to 5 year BS-MS Dual degree Program 2016

Admission Form
Please tick appropriate boxes
1.

Application Number:

2.

Stream:

KVPY

3.

Category:

GE

4.

PD:

5.

Applicants Name:

6.

Date of Birth (DD/MM/YYYY):

7.

Parents/Guardians Name:

8.

Address for Communication

YES

JEE Advanced
OBC-NCL

SCB
SC

ST

KM

Paste your recent


Passport size
Photograph here

NO

Residence Phone:
Mobile:
Email:

9.

a) I hereby declare that the particulars stated above are true and base don verifiable records.
b) I undertake to present the original documents immediately upon demand by IISER(s).
c) In the event of suppression or distortion of any fact, I understand that my admission/ degree
acquired is liable for cancellation. I understand that even if I get admitted to IISERs, it does not
necessarily entitle me for a fellowship.
d) I also understand that the decision of the IISER Joint Admission Committee regarding my admission
to IISER, Berhampur/Bhopal / Kolkata / Mohali / Pune /Thiruvananthapuram/ Tirupati is final and
I shall abide by the rules, norms and discipline of the IISER where I join.

Signature of the Candidate


Place
Date
Enclosures

All relevant documents as asked for in the offer letter

Signature of the Parent / Guardian