LINGAPURAM (V), THALLAMAPURAM ROAD, PRODDATUR - 5163621(M),
YSR KADAPA(Dt). A.P.
Approved by A.I.C.T.E, New Delhi & Affiliated to JNTUA Anantapur.
Email: principal.bitspdtr@gmail.com. Web: bitspdtr.in. Ph: (08564) 200200 / 201202. Fax; (08564) 200700
Application No:
Academic Year: 2013-14
Application for Admission under B-Category
to First Year B.Tech.
1. Name of the Applicant in Full
(in Block Letters)
:
2. Date of Birth & Age
:
3. Father’s Name
:
4. Occupation & Income
:
5. Mother’s Name
:
6. Occupation & Income
:
7(a) Address for Correspondence
:
Mobile:
Email:
(b) Permanent Address
8. Applicant’s identification marks
Ph.No.(Res) :
Affix
Passport
Size
Photograph
Ph.No.(Off):
:
: 1.
(as in SSC register)
2.
9. Nationality
:
10. Caste / Category OC/BC/SC/ST/
Minority
:
P.T.O.
11. Details of Qualifying Examination.
Course with Specialization
Board /
Univ./Country
Month & Year of
Passing
I Year
Marks
Max.
Secured
Marks
II year
Marks
Max.
Secured
Marks
% of Marks
Division / Class
s.s.c.
Intermediate
Subject
Part-1
Part-2
Part-3
Total Marks
12.
Particulars of EAMCET:
Hall Ticket No.
Marks
Secured
13.
Rank
Particulars of Courses for which admission is requested:
Course
Order of priority of Branch
1
2
B.Tech.
3
4
5
XEROX COPIES OF DOCUMENTS TO BE ENCLOSED WITH THE APPLICATION
1.
EAMCET Rank Card and Hall Ticket, if appeared.
2.
Certificate of Qualifying Examination along with memorandum of marks.
3.
Date of birth certificate (S.S.C. Certificate (OR) its equivalent.
4.
Study / Bonafide Certificate from the Institute where he / she last studied.
Note I Original Certificates must be submitted at the time of admission.
DECLARATION BY THE CANDIDATE
I,. ......................... ............................. S/o,D/o .............................................................
solemnly declare that:
I have passed the qualifying examination of recognized educational institution.
I have not been debarred/rusticated from any educational Institution/Board/University.
All statements made in the application are true to the best of my knowledge and belief I clearly
understand that if any of the statements are subsequently found to be untrue, my admission stands
cancelled.
I promise to abide by the rules and regulations, in force and those that may hereafter be made
for the administration into the institution. I further undertake that, so long as I remain as a student of the
institution I will do nothing either inside or outside the Institution that may interfere with its orderly
working and discipline.
I
also
undertake
that
I
shall
comply
with
any
changes
in
the
Statutes/Ordinances/Regulations/Syllabi that may be made from time to time by the Balaji Institute of
Technology and Sciences or by affiliating university.
I am aware that I should put in necessary percentage of attendance, otherwise I shall be
detained.
I shall not indulge in ragging and if I am involved I am liable to be debarred from the
Institution.
I am aware that, if, I discontinue my studies at Balaji Institute of Technology and Sciences,
whatever be the reason for discontinuation, I undertake to pay the full amount of fees that would have
been paid by me, had I continued to study my course up to completion. Failing to pay the fees, my
original certificates and Transfer Certificate need not be issued to me.
I am aware that I have to pay annually an amount of miscellaneous fee in addition to tuition fee.
In all matters concerning me and the Institution the orders of the officers concerned will be
final and binding on me.
In the event of any legal case between me and the institution it will be in the jurisdiction of
PRODDATUR, YSR KADAPA Dt.
Place: .....................................
Date: .... .............................
(Signature of Candidate)
DECLARATION BY THE PARENT / GUARDIAN (Only if both the parents are not in India)
I, .…….……………………………………………………………………………..…………
do
solemnly affirm that I undertake to be responsible for the conduct of my Son/Daughter/Ward.
Sri/Kum ___________________________________________ and to pay regularly all his/her expenses
during his/her stay at the institution. Further, I am prepared to withdraw him/her if he/she acts against
the rules of the Institute.
I undertake to maintain my Son/Daughter/Ward, Sri/Kum
____________________
____________________________ during his/her study at the institution.
Signature_________________________________
Relationship with the candidate
Address
Date: ___________________
________________________________________________
Place: ___________________
________________________________________________
Telephone No: ____________________________________
(Signature of Parent)
FOR OFFICE USE ONLY
FEE PARTICULARS:
Admit Sri/Kumari/Srimathi
Course & Branch allotted
Date:
Admn. Officer
Secretary
Principal
Yes/No.
Rank
Year
a) Whether the candidate appeared for the EAMCET :
b) If yes, indicate the Rank Secured
c) FEE Particulars:
S.No.
Particulars
Amount (Rs.)
Cash/DD
1.
Admission Fee
D.D. No.:
2.
Tuition Fee
Date:
3.
J.N.T.U. Recognition Fee
Bank:
4.
J.N.T.U. Infrastructure Fee
Receipt No:
5.
Miscellaneous Fee
TOTAL
d) Other Payments:
Sri / Kumari / Srimathi:
is admitted
Course & Branch admitted:
Date:
OFFICE SUPERINTENDENT
Note: Admission is subject to Govt. of A.P.'s orders issued from time to time and approvals from APSCHE
and JNT University, Anantapur.