UPSEE - 2014: Confirmation Page for Application Number :280457

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CONFIRMATION PAGE : UPSEE - 2014

(APPLICATION FORM FOR ADMISSION TO FIRST YEAR IN B.TECH. / B.PHARM. / B.ARCH. / BHMCT / BFAD / BFA/ LATERAL ENTRY (SECOND YEAR) IN B.TECH. AND B.PHARM)

Registration No. 280457

You have successfully submitted Application On-line. Kindly take the printout of this page. Paste your one passport size photograph and put your signature and thumb impression in the specified box. Send this form along with copy of Bank Challan (if fee paid by Bank Challan) to REGISTRAR (UPSEE-2014), UTTAR PRADESH TECHNICAL UNIVERSITY, I.E.T.CAMPUS, SITAPUR ROAD, LUCKNOW-226021, U.P. to reach latest by 5 PM, 07-04-2014. Place of Application Form FillingON LINE APPLICATIONS( OH) Candidate's Name KAPIL KUMAR Date of Birth 21/09/1996 Father's Name HAR PAL SINGH Category UPSC Nationality INDIAN Sub-Category NOT APPLICABLE Parent's Domicile U.P. Rural Weightage NO Gender MALE Qualifying Exam DIPLOMA IN ENGG. Subjects in 10+2 NOT APPLICABLE Qualifying Exam Passed From UTTAR PRADESH Year of Passing 2014 Seeking Admission For SECOND YEAR (DIPLOMA HOLDER ONLY, OTHER THAN B.ARCH.) / B.SC. GRADUATES 2nd Year (Lateral Entry) DIPLOMA IN ENGINEERING Paper(s) to Appear PAPER-6 Choice of Exam Centres 1ST : MORADABAD, 2ND : BAREILLY, 3RD : MEERUT
DECLARATION

I certify that the particulars given by me in this Application Form are correct to the best of my knowledge and belief and any mistake / misinformation detected at the time of counselling or at any stage will result in the cancellation of admission. I have carefully read the Information Brochure of UPSEE 2014 and agree to abide by the terms and conditions laid down therein. Further, it is entirely my responsibility to prove the eligibility for admission to the 1st year of B.Tech. / B.Arch ./ B.Tech. (Agriculture Engg.) / B.Tech. (Bio Tech) / B.Pharma. / B.HMCT / BFAD / BFA / 2nd year of B.Tech. / B. Pharma course in respect of qualification and entitlement for admission against reserved category, if claimed, to the satisfaction of the UPSEE 2014. Further, I undertake that I will be visiting the web site (http://upsee.nic.in, http://www.uptu.ac.in) regularly for any information and I declare that all the information regarding UPSEE-2014 provided on these websites will be treated as served. Mailing Address: Name: Address: District: State: PinCode: Email ID: Mobile No.
KAPIL KUMAR VILLAGE BHOLA SINGH MILAK SONAKPUR DEHAT TEHSIL AND DIST MORADABAD MORADABAD UTTAR PRADESH 244001 BUDDYSMBD@GMAIL.COM 9368014782

Uploaded Signature

Uploaded Thumb Impression

Signature of the Candidate(Not in capital letters) Left Hand Thumb Impression Signature of Parent /Guardian

Send this form along with copy of Bank Challan (if fee paid by Bank Challan) to REGISTRAR (UPSEE-2014), UTTAR PRADESH TECHNICAL UNIVERSITY, I.E.T.CAMPUS, SITAPUR ROAD, LUCKNOW-226021, U.P. to reach latest by 5 PM, 07-04-2014 . Details of Transaction(Punjab National Bank). Transaction ID.: 4111703 Amount: 507.01 Card Type : VISA/Mastercard Date of Transaction 03/04/2014

Registra on No:

280457

Note : Please ensure that all the entries are filled up and transaction details of bank are available on the confirmation page, failing which your application is liable to be rejected.

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4/3/2014 11:47 AM