Innovative Engineers Teachers And Education Societys

LEELAVATI AWHAD INSTITUTE OF TECHNOLOGY M S & R

Affiliated to University of Mumbai, Approved by D.T.E. & A.I.C.T.E
Email: admissions@lait.in
Form No
Opposite Gajanan Maharaj Temple, Kanhor, Karav Road, Badlapur (W) 421 503.

Phone No.: 0251-2665001

APPLICATION FORM FOR ADMISSION TO FIRST YEAR DEGREE COURSE IN ENGINEERING FOR THE YEAR _________

MHT-CET MARKS :

For Office use only.

/200

Form Reg. No. ___________ Receipt No. _____________ Date : ___________

Verified by : _________ Checked by : _________ Branch Admitted __________
Branch
Order Of Preference

Electronics & Telecommunication

Computer

Mechanical

PHOTO
Electronics

E.g. If your first preference is computer and second Electronics, Write 1 under Computer and 2 under Electronics etc.

CandidatesName_______________________________________________________________________________

Surname
First Name
Fathers / Husbands Name
Sex: Male / Female _______________ Married/ Single _________________ Mother Tongue _______________
Nationality ______________________ Religion ______________________ Caste / Category ________________
Date of Birth: Day _____________ Month ___________ Year ___________ ( In Words ) ___________________
Place of Birth _________________Native Place _______________ Village / Town _______ Taluka ___________
Permanent address _________________________
Present Address: For Correspondence________
_________________________
______________________________________
_________________________
______________________________________
_________________________
______________________________________
Telephone No: (Resi) ________________________
Tel No: (Resi) ________ (Mob.) ____________
Mobile No: (Self) ___________________________
E-mail address: _________________________
(Fathers) ___________________________
DETAILS OF EDUCATIONAL QUALIFICATION
H.S.C. (or Equivalent Qualifying) Exam
S.S.C. (or Equivalent) Exam
Name & address of Institute (XII) _______________
Name and address of Institute / School (X)
___________________________________________
_____________________________________
___________________________________________
_____________________________________
Month & Year of passing _______________________
_____________________________________
Aggregate marks obtained __________ Out of ______
Month & Year of passing ________________
Marks obtained in PCM ________________ Out of 300
Aggregate marks obtained ______ Out of 750
Marks Obtained in the following subjects at MHT-CET-2010

Maths: ___________________________ Out of 100

Physics: ___________________________ Out of 50
Chemistry: _________________________ Out of 50
Total Marks in MHT-CET _____________ Out of 200
FATHERS DETAILS
Surname _______________________________________
First Name _____________________________________
Fathers Name __________________________________
Profession _____________________________________
Office Address__________________________________
______________________________________________
Telephone: (1) ______________ (2) ________________
Mobile No.:____________________________________
E-mail: ________________________________________
Total Annual Family Income from all Sources __________

Marks Obtained in the following subjects at H.S.C.

Maths: __________________________ Out of 100
Physics: _________________________ Out of 100
Chemistry: _______________________ Out of 100
AIEEE CET: _____________ Out of _____________
Other CET: _____________ Out of _____________
MOTHERS DETAILS
Surname _____________________________________
First Name ___________________________________
Fathers / Husbands Name _____________________
Profession ___________________________________
Office Address _______________________________
___________________________________________
Telephone: (1) _____________ (2) _______________
Mobile No.: _________________________________
E-mail: _____________________________________
Total No. of persons in the family ____________

DETAILS OF LOCAL GUARDIAN (IF ANY)

Surname _____________________________________
First Name ____________________________________
Fathers / Husbands Name _______________________
Residential Address ______________________________
______________________________________________
Tel. No. (O) ______________ Mob. _________________
Declaration to be signed by the Candidate:

Relationship with candidate _____________________

Profession ___________________________________
____________________________________________
Office Address ________________________________
____________________________________________
Tel. No. (O) ______________ Mob. ________________

I, ________________________________________________, declare that I have read all the Rules of Admission for the current year and with full
understanding of these rules, I have filled in this form of application for admission for the current year.
The information given by me in my application is true to the best of my knowledge and belief.
I have not been debarred from appearing at any examination held by any Government constituted or statutory examination authority in India.
I fully understand that the offer of a course or a branch of Engineering will be made to me depending on my inter-se merit and available of a seat at
the time of scrutiny of my application, when I report to the admission authority according to the schedule of admission, displayed on the college
notice board.
I understand that no other document, other than attached to the application form, will be entertained later on for the purpose of claims /
concessions, etc. in connection with my admission.
I hereby agree to confirm to any rules, acts and laws enforced by Government and the University and I hereby undertake that so long as I am a
student of this college, I will do nothing either inside or outside the college, which may result in disciplinary action against me under the rules, acts
and laws.
I fully understand that the Principal of the college will have full liberty to expel / rusticate me from the college for any infringement of Rules of
conduct and Discipline, prescribed by the College / University. Also agree to pay increased fees time to time approved by SHIKSHAN SHULK
SAMITTEE or any other authority appointed by Government of Maharashtra,
I fully understand that in case I apply for cancellation of admission, refund of fees will be as per the rules of refund notified in the college
admission brochure, declared by the Government Authority.
I fully understand that smoking, drinking of Alcoholic beverages, chewing of paan or gutka or ragging in college premises is strictly prohibited.
Bringing of cell phones or any other electronic devices except non-programmable calculators are strictly prohibited and if brought, will be
confiscated by the college authorities. Strict action will be taken against those who break the above rules.
I enclose herewith attested copies of documents, (Put marks in the boxes)
1. S.S.C. Marksheet
2.
3.

H.S.C. Marksheet
H.S.C. leaving Certificate / place of birth

4.
5.
6.

MHT-CET-2010 / AIEEE CET Marksheet

Nationality Certificate
If H.S.C. Examination is not passed from Maharashtra State Board, then provisional
Statement of eligibility from Registrar, University of Mumbai.
7. Domicile Certificate of Maharashtra State
8. Affidavit for Gap in Studies, if any
Place: __________________
Date: __________________
Signature of Candidate
DECLARATION TO BE SIGNED BY THE PARENT / GUARDIAN: ________________________________________
I, _____________________________________________, declare that the particulars furnished by my son /ward in this application
form are correct to the best of my knowledge.
I undertake and bind myself to pay behalf of my son / daughter /ward such fees, charge etc., approved by the Shikshan Shulk
Samittee or any other appointed by the govt. of Maharashtra and any other fees which the Government of Maharashtra /
University of Mumbai may levy from time to time by due date and in the event on my part / or on the part of my son
/daughter/ward, the Principal of the college may take such action against my son / Daughter / Ward, as he / she may deem fit.
I FULLY UNDERSTAND THAT IN CASE MY WARD APPLIES FOR CANCELLATION OF ADMISSION, REFUND OF FEES WILL BE AS PER THE
RULES OF REFUND NOTIFIED IN THE ADMISSION BROCHURE OF THE INSTITUTE, OR AS DECLARED BY THE CONCERNED AUTHORITIES,
WHICH I HAVE CAREFULLY READ AND UNDERSTOOD.
I ASSURE YOU THAT MY WARD WILL POSITIVELY OBEY ALL THE ABOVE RULES.
Place: _______________
___________________________
Date: _________________
(Name & signature of the Parent / Guardian)