HINDU INSTITUTE OF MANAGEMENT & TECHNOLOGY

BHIWANI ROAD , ROHTAK

 

Photograph

Roll No.

Class 

Amount  

Receipt No. & Date

         (For office use only)                                                                                 No form will be accepted

                                                                                                                             Without photograph

Application For Admission to MCA Course

I.                 Class to which admission is sought.         

Particulars of student

1. Full Name:

   (In Block letters)

2. (a)  Father’s  Name 

    (In Block letters)

     (b) Mother’s Name

     (In Block letters)

3.  Date of Birth           :             Day                                Month                                  Year

                                                                                                                         As per Matric Exam  4.Registration No. Of University (if any)           

5. Father’s Occupation                                           Monthly Income       

6.   (a)   Permanent Home Address

      (b)   Address for Correspondence

Phone  

7.    Nationality                                                            State to which you belong

8.   Were you ever disqualified by any University/Board to appear in any examination? if yes, give

     Details

9.   Tick the appropriate category you belong to

       General                                         Schedule Caste                                 Schedule Tribe                 

       Back. Class (A/B)                       Physically Handicapped                   Freedom Fighter

       Ex-service Man                           Wards of Military & Para Military Personal 

10.  Weather NRI / NRI sponsored /Industry sponsored of Foreign Nationals

                     Yes                                           No          

   If yes mention the category        

11.    Are you a sportsman /Player of State /National /International Level :

                         Yes                                              No

12.    Are you a daily Passenger?                  

Do you want to get a bus pass?

13.    Educational Qualification

Declaration By The candidate

            I declare that information submitted in this form are correct to the best of my knowledge and belief, I am conscious that if any information is found to be incorrect, my admission is liable to be cancelled.

II.                            Place:                                                                                Signature of the Candidate

Undertaking By Parents/Guardians

I                              hereby undertake to pay all the fees of my ward during his/her study in Hindu institute of management & Technology and he/she will not leave the institute during the course. If he /she do so then I shall pay all the fees & expenditure for the full duration of course. I shall furnish the bank guarantee for the same.

I shall also be responsible for his/her conduct & behavior during his/her period of study in this institute. He/she will not indulge in any such activity which adversely affects the discipline, dignity & honour of the institute. If any punishment is given for such type of activity, I shall accept the same.

Place:

Date:                                                                                        (Signature of parents/Guardian)

Checked By

Copies to be attached: -                                                                                 Director/Principal

i)                    Character Certificate

ii)                   Photocopies of Certificates of all examinations passed.

iii)                 Caste Certificate in case of S.C/B.C./S.T.

iv)                 An AFFIDAVIT in case of a Gap Year student.

v)                  Certificate in case of PH/ESM.

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