CALICUT UNIVERSITY INSTITUTE OF ENGINEERING AND TECHNOLOGY THENHIPALAM. P.O.- 673 636, KERALA. PH: Office- 0494-2400223,Principal:0494-2407370 www.cuiet.info APPLICATION FOR ADMISSION TO FIRST YEAR B.TECH DEGREE 2015-16( NRI QUOTA ) Application No. Name of NRI Relationship with the applicant NRI Account No. Employment Certificate Passport No. Residing country (Photo) 1. NAME IN CAPITALS (As given in 12th or equivalent Certificate) 2. Date of Birth in Christian Era (in words & figures) 3. Sex (write Male or Female) 4. Nationality 5. Religion & Caste 6. (Whether belongs to SC/ST/OEC/SEBC/General 7. a Name & Address Applicant 7.b Address to which communications are to be sent with Telephone Number, Mobile, e-mail. 8. Name Occupation & Address with Telephone No. ,Mobile ,E-Mail of a. Father b. Mother 9. Qualifying Examinations passed. (12th Std./Pre- Degree/Diploma) Name of Examination School / College With Address Board/University Year of Passing No. of Attempt Taken c. Guardian/Relationship 10. Marks obtained in the qualifying Examination Subject Marks secured Maximum Marks Percentage of Marks obtained Mathematics Physics Chemistry Total 11.Details of Xth Examination Name of Exam 12. Branches to which admission is sought (In order of preference) 1. Name of the Institute Name of the Board Year of Passing 2. 3. 4. 5. DECLARATION I do hereby solemnly affirm 1. that the statements made and information furnished in my application as also in all the enclosures thereto submitted by me are true. 2. that I have filled the application form myself and if any statement I have made is found to be false or incorrect I shall be liable to such action as the Institute may deem proper. 3. that I shall strictly abide by the rules and regulations of the Institution and other Instructions from the Head of the Institution from time to time. 4. that I have neither been involved in any criminal case nor in any case pending against me in a Court of law and I submit myself to the disciplinary jurisdiction of the Principal and other authorities of the Institute. 5. that I have obtained the minimum marks in the qualifying Examination prescribed by the University of Calicut and the Commissioner for Entrance Examinations, Government of Kerala for admission to First Year B.Tech/Lateral Entry. 6. that I understand if I am found ineligible for admission to B.Tech at any point of time during the course of study my admission will be cancelled and I will be removed from the roll of the Institute. 7. that I will not involve in any incident of ragging or unlawful activities and I am aware if I am found involved in any such incident I will be expelled from the Institution and will be proceeded as per the existing law of the land. Place : Date: Signature of the Applicant. Declaration by Parent/Guardian I ………………………………………………………………………….undertake the responsibility of my son/daughter/ward…………………………………………………………………………..who is seeking admission to Calicut University Institute of Engineering & Technology and declare that the facts furnished by him/her are correct and true and if in future, any fact is found to have been furnished falsely or incorrectly or any information suppressed to secure admission, I shall withdraw my son/daughter/ward from the course without any claim or consideration for the period of study/stage of the course he/she has completed. I ………..…………………………………………………. further declare that I fully understand the consequence of my ward’s involvement in any ragging incident as per the Supreme Court and AICTE directives in this regard. Place : Date : Signature of the Parent/Guardian.