Sr. No.

_____________

Estd. 1997
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Shri Krishan Institute of Engineering & Technology Estd. 2005
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SKIET And SKP

Shri Krishan Polytechnic
Approved by AICTE, DTE & Affiliatecd to Kurukshetra University
Sirsla Road, Ratan Dera, P.O. Pipli, Kurukshetra 136 131 (Haryana)
Affix Your
Registration/Admission Form Recent
Passport Size
(USE CAPITAL LETTERS ONLY) Coloured
Photograph

1. Name: (As given in 10th Certificate)

2. Date of Birth: 3. Sex (Tick Ö): Male Female 4. Nationality:........................

5. Father's Name: ............................................................................................................................. (As given in 10 th
Certificate)

6. Permanent / Correspondence Address: .......................................................................................................................

City: ........................................................ State:.......................................................... Pin Code ....................................
Contact No.(With STD Code):...........................................................Mob: ..................................................................
Email ID:.............................................................................................................................................................................
7. Category (SC/ ST/ OBC / GEN.) : 8. Domicile State:
9. Course for which seeking admission (M.Tech - CSE, B.Tech - CSE, IT, ME, CIVIL, ECE), (Management -
MBA & BBA), (Diploma- CSE, ME, CIVIL, ECE, EE, AE):-

Course ................................................................. Direct/ LEET/DET-L .............................. Branch ...........................

10. AIEEE/MAT CAT/ GATE / DET / LEET / DET-L (Tick Ö as aplicable)
Rank Roll No.
11. (a) Academic Record :
Max. Marks Yr. of
Sr. Exam University/Board Roll No. %age
Marks Obtd. Passing
1 10th

2 10+2 (PCM Only)

3 Graduation ..........................

4 Others ..................................

(b) Gap Years: ...................................................................................................

(c) Have you ever been disqualified from studies : YES/NO
12. Parents Information:
Parent's & Guardian Details Occupation Contact Nos. & Email ID

Father

Mother
13. Detail of Guardian:
Name: ........................................................................................................... Relationship: ............................................
Address: .............................................................................................................................................................................
Contact Details: ...........................................................................Email ID:....................................................................
Guardian Annual Income:
14. In case of any emergency, who should be contacted:
Name: ........................................................................................................... Relationship: ............................................
Address: .............................................................................................................................................................................
Contact Details: ...........................................................................Email ID:...................................................................
15. Applying for Hostel : YES/NO
16. Documents Attached (Equivalent to):
(a) 10th .......................................................... (b) 10+2 ..........................................................
(c) ITI ............................................................ (d) Graduation .............................................
(e) SC/ST....................................................... (f) Domicile ..................................................
DECLARATION
I) I_______________________________________________________ hereby certify & confirm that the information filled in the
Applications Form is complete and accurate in all respect, I understand and agree that misrepresentation of facts will justify
denial of admission/ cancellation of admission/ expulsion from the institute.
ii) If at any stage, it is found that I do not fulfill the minimum prescribed eligibility criteria of the University/Haryana Technical
Board, admission granted to me by the Institute can be cancelled and I will have no right/claim towards the Institution.
iii) I declare that information furnished by me in the application form is true in all respects and in case any entry or information is
found to be false, this shall result in automatic cancellation of my admission besides rendering me liable to such action as the
university may deem fit. I hereby undertake that I have carefully gone through the eligibility conditions prescribed in the
prospectus/website for the programme. I am applying for and shall appear in the entrance examination/direct counseling of
the Institute after satisfying myself that I do fulfill the same.

Place: ..................................... ........................................... ...........................................

Date: .........../........../............... Guardian's Signature
(with relation & full Name) Student's Signature

FOR OFFICE USE ONLY

Details of Fee Deposited (Amount) Category : SC/ST/OBC/Gen.

by Draft / Cheque / Cash Receipt No. .................................. Bank .............................................. Date .........................

Registration No. ......................................... Roll No. .................................. Admitted to Course ...................................

Branch ........................................ Reference: .........................................................................................................................

CHECKED BY VERIFIED BY:

Signature ............................................. Signature .............................................

...................................................
Name .................................................... Name .................................................... Director/Chairman

Remarks........................................................................................................................................................................................................