GAUTAM BUDDH TECHNICAL UNIVERSITY, LUCKNOW

(Formerly Uttar Pradesh Technical University, Lucknow)

APPLICATION FORM FOR ADMISSION TO M.TECH./M.PHARM.
PROGRAMME
CHECKLIST
(Tick the Enclosed Documents. Please enclose only attested COPIES. Please
refer to the ADMISSION PROCEDURE for bringing along the ORIGINALS for
verification. Wherever applicable, mention the CERTIFICATE NO. as
prescribed in ADMISSION PROCEDURE)

Sl No Tick Particulars
1* Print out of On-Line Application Form (with photograph)
2* Demand Draft of Rs 1000=00 (or Rs 500=00) in favour of The Finance Officer,
Gautam Buddh Technical University, Lucknow payable at Lucknow.
3* Date of Birth Certificate or the High School (class X) Certificate with Date of Birth.
4* SC/ST/OBC/DOMICILE etc certificates (all those are applicable).
5* Copies of degrees, marks/grade sheets of all the examinations passed.
6* Medical Certificate
7 Copy of GATE SCORE (if applicable)
8 No Objection Certificate from the employer (for employed applicants).
9 Copies of publications (if applicable).
Total No. of Enclosures : . No. of Sheets :
1. : Required

Signature

Name






GAUTAM BUDDH TECHNICAL UNIVERSITY, LUCKNOW
(Formerly Uttar Pradesh Technical University, Lucknow)
M. TECH. and M. PHARM. PROGRAMME
ADMISSION PROCEDURE
1. ADMISSIONS

1.1 Gautam Buddh Technical University, Lucknow (Formerly Uttar Pradesh
Technical University (UPTU), Lucknow) coordinates and awards post
graduate masters degree leading to Master of Technology (M. Tech.) and
Master of Pharmacy (M. Pharm.) Degrees in certain fields of specialization.
The programmes are conducted at various institutions approved by University
from time to time.
1.2 The process of admissions to the M. Tech. and M. Pharm. Programme is
centrally coordinated by the University for all the fields of specialization
and for all the institutions listed in section 2.
1.3 Reservation in admission shall be governed by the U.P. State Govt. rules. In
case of non-availability of suitable candidates in any category, the decision of
University for filling up vacant seats shall be final.

2. COURSES OFFERED

2.1 M. Tech. Programme/ Institutions/ Intake
(i) Govt. / Govt. Aided Institutions
Institute
Code
Name of the Institution Stream of
Engineering/
Technology
Specialization of M. Tech. Programme Intake
042 M.M.M. Engineering
College, Gorakhpur
Civil 1. Environmental Engineering 18
Civil 2. Hill Area Development Engineering 18
Civil 3. Seismic Design & Earthquake Engineering 18
Civil 4. Structural Engineering 18
Electrical 5. Power Electronics and Drives 18
Electronics 6. Digital Systems 18
7. Communication Engineering 18
Mechanical 8. Computer Integrated Manufacturing 18
Computer
Science
9. Computer Science and Engineering 18
10. Information Technology 18

043 Bundelkhand Institute of
Engineering &
Technology, Jhansi.
Electronics 1. Digital Communications 20
Civil 2. Construction Technology & Management 18
Mechanical 3. Manufacturing Science & Technology 18
Civil 4. Environmental Engineering 18
Mechanical 5. Thermal Engineering 18
044 Uttar Pradesh Textile
Technology Institute,
Kanpur.
Textile 1. Textile Technology 12
Textile 2. Textile Chemistry 18
045 Harcourt Butler
Technological Institute,
Kanpur
Chemical 1. Chemical Technology with specialization in
Bio-Chemical Engineering/ Food Technology/
Oil Technology
34
2. Chemical Engineering 18
Mechanical 3. Computer Aided Design 18
Electronics 4. Electronics & Communication Engineering 18
Civil 5. Environmental Science & Engineering 18
052 Institute of Engineering &
Technology, Lucknow.
Civil 1. Environmental Engineering 18
Bio-Technology
2. Bio-Technology 18
Electronics 3. Micro-Electronics 15
104 Kamla Nehru Institute of
Technology, Sultanpur.
Electrical 1. Power Electronics & Drives 18
Mechanical 2. Thermal Engineering 18
Civil 3. Geotechnical & Environmental Engineering 18
Computer
Science
4. Computer Science & Engineering 18
Electronics 5. Communication Engineering 18
190 DOEACC Centre,
Gorakhpur
Electronics 1. Electronics Design and Technology 18

(ii) Private Institutions
Institute
Code
Name of the Institution Stream of
Engineering
Specialization of M. Tech. Programme Intake
010 United College of
Engineering and
Research, Allahabad
Computer Science 1. Computer Science & Engineering 18
Mechanical 2. CAD (2
nd
Shift) 24
Electronics 3. Power Electronics (2
nd
Shift) 24
014 Sri Rammurty Smarak
College of Engineering
& Technology, Bareilly
Mechanical 1. CAD-CAM 15
Computer Science 2. Software Engineering 15
Electronics 3. Microwave Engineering 18
Electrical 4. Electrical Drive & Control 18
046 Maharana Pratap
Engineering College,
Lucknow
Electronics 1. Electronics & Communication Engineering 18
Mechanical 2. Mechanical Engineering 18

053 Azad Institute of
Engineering &
Technology, Lucknow
Electronics 1. Instrumentation & Control Engg 18
Mechanical 2. Advance Computer Aided Design 18
Computer Sc. 3. Distributed System (Second Shift) 18
Information
Technology
4. Infrastructure Management (2
nd
Shift) 18
Mechanical 5. Industrial & Production Engg,( 2
nd
Shift) 18
054 B.B.D. National Institute
of Technology &
Management, Lucknow
Mechanical 1. Production Engineering 18
056 Babu Banarasi Das
Northern India Institute
of Technology,
Lucknow
Electronics 1. Digital Communications 18
123 Saroj Institute of
Technology &
Management, Lucknow
Computer Science 1. Computer Science & Engineering 18
Electronics 2. Electronics & Communication Engineering 18
Electrical 3. Power Electronics 18
Mechanical 4. Thermal Engineering 18
Computer 5. Information Technology 18
138 B.B.S. College of
Engineering &
Technology, Allahabad
Mechanical 1. Advanced CAD 18
141 Sagar Institute of
Technology &
Management, Barabanki
Mechanical 1. Mechanical Engineering 18
145 College of Science &
Engineering, Jhansi
Computer Science 1. Computer Science & Engineering 18
Electronics 2. Electronics & Communication
Engineering
18
Civil Engineering 3. Civil Engineering 18
Mechanical 4. Mechanical Engineering 18
162 Shambhunath Institute
of Engineering &
Technology, Allahabad
Electronics 1. VLSI Design 24
Mechanical 2. Production Engineering 24
164 Pranveer Singh Institute
of Technology, Kanpur
Electronics 1. Electronics & Communication Engg. 18
Mechanical 2. CAD 18
Computer 3. Computer Science & Engineering 18
165 Kanpur Institute of
Technology, Kanpur
Computer Science 1. Computer Science & Engineering 18
Electronics 2. Electronics & Communication Engineering 18
Mechanical 3. Mechanical Engineering 18
254 Bhabha Institute of
Technology, Kanpur
Dehat
Mechanical 1. Mechanical Engineering 18
Electronics 2. Electronics & Communication Engg. 18
284 United Institute of
Technology, Allahabad
Electronics 1. Electronics & Communication Engg. (2
nd

Shift)
24
Computer Sc. 2. Computer Science & Engg. (2
nd
Shift) 24
360 Goel Institute of
Technology &
Management, Lucknow
Computer Sc. 1. Computer Science & Engineering 18
Electronics 2. Electronics & Communication 18
361 R.R. Institute of Modern
Technology, Lucknow
Mechanical 1. Mechanical Engineering (2
nd
Shift) 24
2. Electronics Engg. (2
nd
Shift) 24

M. Pharm. Programmes / Institutions / Intake Private Institutions

Institute
Code
Name of the Institution Specialization of M. Pharm. Programme Intake
012 Pharmacy College, Azamgarh 1. Pharmacology 18
2. Pharmaceutics 18
3. Pharmaceutical Chemistry 18
014 Sri Rammurty Smarak College of Engineering &
Technology, Bareilly
1. Pharmaceutics 18
041 Archarya Narendra Dev College of Pharmacy,
Gonda
1. Pharmaceutical Chemistry 10
056 B.B.D. Northern India Institute of Technology,
Lucknow
1. Pharmaceutical Chemistry 18
2. Pharmacology 18
3. Pharmaceutics 18
123 Saroj Institute of Technology & Management,
Lucknow
1. Pharmaceutical Chemistry 18
2. Pharmacognosy 18
3. Pharmaceutics 18
144 Prasad Institute of Technology, Jaunpur 1. Pharmaceutics 18
2. Pharmacology 18
164 Pranveer Singh Institute of Technology, Kanpur 1. Pharmaceutical Chemistry 18
2. Pharmaceutics 18
3. Pharmacology 18
167 Rajarshi Rananjay Sinh College of Pharmacy,
Sultanpur
1. Pharmaceutics 18
2. Pharmacology 18
168 Smt. Vidyawati College of Pharmacy, Jhansi 1. Pharmacology 18
2. Pharmacognosy 18
169 Rakshpal Bahadur College of Pharmacy, Sultanpur 1. Pharmaceutics 18
2. Phramaceutical Chemistry 18
186 Kamla Nehru Institute of Management &
Technology, Sultanpur
1. Pharmaceutical Chemistry 10
2. Pharmaceutics 18
3. Pharmacognosy 18
188 Advance Institute of Biotech & Paramedical
Sciences, Kanpur
1. Pharmaceutics 18
2. Pharmaceutical Chemistry 18
3. Pharmacology 18
4. Pharmacognosy 18

197 Azad Institute of Pharmacy & Research, Lucknow 1. Pharmaceutics 30
2. Pharmaceutical Chemistry 18
3. Pharmacology 18
202 Hygia Institute of Pharmaceutical Education and
Research, Lucknow
1. Pharmacology 18
2. Pharmaceutics 18
3. Pharmaceutical Chemistry 18
203 Rameshwaram Institute of Technology &
Management, Lucknow
1. Pharmacology 18
2. Pharmaceutics 18
3. Pharmacognosy 18
4. Pharma Chemistry 18
233 R.K.College of Pharmacy,Azamgarh 1. Pharmacology 18
236 Sir Madan Lal Institute of Pharmacy, Etwah 1. Pharmaceutics 18
2. Pharmacology 18
3. Pharmacognosy 18
246 Dayanand Dinanath College, Institute of Pharmacy,
Kanpur
1. Pharmaceutics 18
260 IBNE SEENA Pharmacy College, Hardoi 1. Pharmaceutics 18
262 Institute of Pharmaceutical Science and Research,
Unnao
1. Pharmaceutics 18
315 United Institute of Pharmacy, UCER Allahabad 1. Pharmacology 18
2. Pharmaceutics 18
316 Aryakul College of Pharmacy & Research,
Lucknow
1. Pharmacology 18
2. Pharmaceutics 18
3. Pharma Chemistry 18
391 Mahatma Gandhi Institute of Pharmacy, Lucknow 1.Pharmacology 18
2. Pharmaceutics 18
392 Goel Institute of Pharmacy & Sciences, Lucknow 1. Pharmaceutics 18
2. Pharma Chemistry 18


3. ELIGIBILITY CRITERIA:

3.1. The applicant for M. Tech./ M. Pharm. programmes must fulfill the
following criteria:

i. General/ OBC candidates, with 60 % marks in graduation in Engineering or
Technology/ B. Pharm. or equivalent, are eligible.

ii. SC/ST candidates, with 55 % marks in graduation in Engineering or Technology /
B.Pharm. or equivalent, are eligible.

iii. For admission to M.Tech. (Computer Science, Information Technology and
related branches), candidates having degree of MCA, M.Sc.(Computer Science)
or M.Sc. (Information Technology) with at least 60% marks for General/OBC
candidates and 55% marks for SC/ST candidates are also eligible.

iv. For admission to M.Tech. (Electronics Engineering and related
branches), candidates having degree of M.Sc. (Electronics) with at least 60%
marks (for General/OBC candidates), and 55% marks (for SC/ST candidates) are
also eligible.

v. For admission to M.Tech. (Chemical Technology and related branches),
candidates having degree of M.Sc. (Chemistry) with at least 60% marks (for
General/OBC candidates), and 55% marks (for SC/ST candidates) are also
eligible.

vi. For admission to M.Tech. (Hill Area Development Engineering)/
M.Tech. (Environmental Engineering), B.Tech. /B.E. or equivalent in any branch
of engineering/technology OR B.Arch. or equivalent. OR M.Sc. in any discipline
or Masters degree in Mathematics / Geography with at least 60% marks (for
General/OBC candidates), and55% marks (for SC/ST candidates) are also eligible.

Candidates not having Mathematics at Intermediate level shall be required to
compulsorily qualify a non-credit course on Mathematics of Intermediate level in
the first semester of M.Tech. programme.

vii. For admission to M.Tech.(Bio-Technology), candidates having degree of M.Sc.
in Physical/ Chemical/ Biological/ Veterinary/ Agricultural Science or
Biotechnology or Bioinformatics or equivalent degree in relevant disciplines or
B.E./B.Tech. in Chemical /Bioinformatics /Biochemical /Food/Agriculture/
Environmental or equivalent degree in relevant discipline or MBBS/
B.Pharm./ B.V.Sc./B.D.S with at least 60% marks (for General /
OBC candidates), and 55% marks (for SC/ST candidates) are also eligible.

viii. For admission to M.Tech. (Plastic Engineering), candidates having degree of
B.Tech./ B.E. in Chemical Engineering/ Chemical Technology / Polymer Science
& Technology / Mechanical Engineering / Production Engineering/
Petrochemical Technology or equivalent of above degrees / course or M.Sc.
Chemistry / Industrial Chemistry / Polymer Science with at least 60% marks (for
General / OBC candidates), and 55% marks (for SC/ST candidates) are also
eligible.

ix. For admission to M.Tech. (CAD-CAM), candidates must have B.Tech./ B.E. in
Mechanical Engineering/Automobile Engineering / Chemical Engineering/
Chemical Technology / Civil Engineering or allied branches with at least 60%
marks (for General / OBC candidates), and 55% marks (for SC/ST candidates).

x. For admission to M.Tech. (Automation & Robotics), candidates must have
B.Tech. / B.E. in Mechanical Engineering/Electrical Engineering/ Electronics &
Communication Engineering / Computer Science & Engineering or allied
branches with at least 60% marks (for General / OBC candidates), and 55%
marks (for SC/ST candidates).

3.2 The equivalency of any degree for admission to any programme will be decided
by the University. The eligibility criteria given above are minimum and mere
possessing the same does not qualify the eligibility for admissions. University
may prescribe any other requirements over and above these conditions.

4. SELECTION PROCEDURE

4.1 The candidate has to fill an application form on-line with all the
relevant details and send print copy of the same along with requisite fee
and certified copy of documents related to qualifications on or before the
last date prescribed by the University. The on-line application is available
on website www.uptu.ac.in. The candidates should fill in and sign the
check list and submit along with the form.
4.2 The sort-listed eligible candidates shall be called for counselling. The
schedule of counselling will be available on the University website
www.uptu.ac.in.
4.3 The number of seats, programmes & institutions may change under very
special circumstances. The same will be posted on the website of the
university.
4.4 Students having domicile of Uttar Pradesh shall be given first
preference and subsequently the candidate having domicile outside
U.P. will be considered only if seats are vacant/ unfilled.
4.5 Candidates with qualifications stated in Section 3 and with valid
GATE/GPAT scores will be given first preference in admission.
4.6 Graduates in Engineering / Technology without valid GATE/GPAT scores
will be given second preference in admission.
4.7 However, the candidates with eligibility criteria as stated in section 3,
and B.Tech. / B.Pharma at graduation level shall be preferred over MCA/
M.Sc. candidates at the time of counseling.

5. RESERVATIONS: Reservation shall be applicable as per the State Govt.
norms as prescribed by the Technical Education Department.
6. MEDICAL STANDARDS
6.1 Candidates called for counseling will have to submit an undertaking for Medical
fitness on Certificate Number- 5.
6.2 The candidate should have to submit Medical certificate on proforma given as
Certificate Number - 4 at the time of admission in the college allotted.
Physically Handicapped / Disabled:
Type I Minimum 40% permanent Visual impairment
Type II Minimum 40% permanent Locomotors disability
Type III Minimum 40% permanent speech and Hearing impairment

7. COUNSELING
7.1 Counseling shall be held at G.B. Technical University (formerly U.P. Technical
University, Lucknow), IET Campus, Sitapur Road, Lucknow. The information
about counseling schedule, procedures and list of sort listed candidates will
be available on website: www.uptu.ac.in. only after 26
th
August, 2012. NO
separate counseling letter shall be sent. The candidates are advised to visit
website frequently for counseling details.
7.2 The candidates called for counseling will be required to come with original
certificates of qualifying examination, mark sheet, weightage certificate,
domicile and category/reservation certificates etc. with one attested copy of
each. In case the candidates do not submit the proper category/ reservation
certificate in the prescribed proforma at the time of counseling, the advantage of
reserved category shall not be provided and they will be treated in General
Category. If a candidate has passed qualifying examination from outside of
U.P., he/she has to bring the domicile certificate of his/her parents (Father or
Mother) only at the time of counseling. The candidate must note that his/her
domicile certificate is not acceptable, in place of his parents certificate and
no request shall be entertained for relaxation.
7.3 Verification of original documents shall be carried out at the time of counseling.
The candidates will not be considered for admission if he/she does not submit
the original documents at the time of counseling. However the originals will be
returned to candidate after verification.
7.4 The initial fee of Rs. 5,000/- will be deposited at counselling centre in the form
of Bank draft. This fee is adjustable against total fee payable at Institution if
candidate takes admission at allotted institute. The initial fee of Rs. 5,000/- will
be forfeited if the candidate does not take admission in the allotted institution.
Requests for return of this fee in such case will not be entertained.
7.5 In addition to initial fee the candidate called for counselling has to deposit a
separate bank draft of Rs. 500/- as counselling fee. This counselling fee is non-
refundable.
7.6 All the Bank drafts must be prepared separately and drawn in favour of Finance
Officer, G. B. Technical University, Lucknow payable at Lucknow.

8 DOCUMENTS REQUIRED AT THE TIME OF COUNSELLING
The candidates are required to bring the following documents, in original along
with one set of photocopies with them at the time of Counseling:
(a) High School Certificate.
(b) Mark sheets of qualifying examination.
(c) Valid GATE Score Card
(d) Category and Subcategory certificate(s), if applicable.
(e) Passport size Photos. (2 Nos.)
(f) Domicile Certificate
(g) Medical Certificate / Undertaking

9 DOMICILE REQUIREMENTS
9.1 Candidates, who have passed the qualifying examination from an institution
located in the State of Uttar Pradesh and who do not claim for any reserved
category are eligible for admission to all the courses at all the institutions against
available General (OPEN) seats (No certificate required).
[Code: UPGE]
9.2 Candidates, who have passed the qualifying examination from an institution
located in State of U.P.; and are domicile of U.P.; and belong to Schedule Caste
(SC) of U.P. / Schedule Tribe (ST) of U.P. / Other Backward Classes of U.P. are
eligible for admission against available reserved seats of their category.
Certificate no. 1 or 2 as applicable is required.
[Respective Codes: UPSC / UPST / UPBC]

9.3 Candidates, who have passed the qualifying examination from an institution
located outside U.P.; and whose parents are domicile of U.P.; and who have not
claimed for any reserved category, are also eligible for admission to courses
offered at all institutions under General (OPEN) category. Such candidate has to
produce the domicile certificate of his/her parents (Father or Mother only) at
the time of counseling (certificate no. 3).
[Code: UPGD]
9.4 Candidates, who have passed the qualifying examination from an institution
located outside U.P.; and whose parents are domicile of U.P.; and who belong to
Schedule Caste of U.P. / Schedule Tribe of U.P. / Other Backward classes of
U.P. are also eligible for admission against reserved seats of their category. Such
candidate has to produce the domicile certificate of his/her parents (Father or
Mother only) (certificate no. 3) and category certificate (no. 1 or 2 as
applicable) at the time of counseling.
[Respective Codes: GDSC/GDST/GDBC]

Proforma of various certificates are available in Appendix A

10. OTHER INFORMATIONS

1. Incomplete applications will be rejected.
2. No TA / DA will be admissible to the candidates called for counseling.
3. The decision of the University for the selection of candidates shall be final.

11. INSTRUCTIONS FOR FILLING ON-LINE APPLICATION FORM
Select any of the courses (M. Tech. or M. Pharm.) from the Course Dropdown.
After selecting the course, the related specialization options would appear in the
Specialization section.
Select Specialization as per your choice by clicking on them and you can select multiple
specialization by pressing control button on the keyboard and selecting the specialization or
you can select it one by one also.
After making the selections click the Right Arrow button on the screen to move
them in the selection list pane.
If you want to remove some of the specializations from the selection pane, select by clicking
on it and click the Left Arrow button on the screen to move them back into the
Select Specialization field.
After making the complete selection, click on the Submit button to navigate to the Form
page for filling the application.
Click Reset button to clear all the selected fields on this page, in-case of any mistake.
On the Form page, fill in the Draft number, Name of the draft issuing bank, Date of
Issue ( DD/MM/YYYY format) and Amount from the dropdown (Rs. 500 or Rs. 1000)
Then fill in all the particulars of the candidate viz. Name, Date of Birth, Fathers name,
Address, Telephone, Mobile, Fax and Email along with the Category, Gender, Domicile and
Nationality (Indian or Others).
Further, fill in the Particulars of Qualifications which is Examinations passed,
Subject/Branch, Name of University/Institution, Year of Passing, Division and Percentage of
Marks. Fill in the till-date aggregate total in case for the candidates who have appeared for
the final examination and are waiting for their final result.
Fill in your GATE score details, if available.
Fill in the field Place, Upload your Photograph by clicking the Browse button and
selecting your scanned Photograph saved on the hard-drive of your system. MAKE SURE
THAT THE PHOTOGRAPH IS IN JPEG FORMAT AND IT SHOULD NOT BE
MORE THAN 100 MB.
Click and check the Checkbox for the declaration from the student that at all the information
furnished is correct then click Submit button to submit the filled form.
Click Reset button to clear all the filled fields on this page, in-case of any mistakes or if you
want to fill the un-submitted Form again.
Click here to download the CHECKLIST which you would be required to send along
with the printout of this form.


AppendixA



CERTIFICATE 1 (sii si)

~-=l-- il--il- (UPSC/UPST/GDSC/GDST)
{4it + - fn + fni faa/si it faa zii sifia)


t nili- l+i i-i t l+ i+c ...........................................................................
zzi i ........................................ l-i=i nizit .............................................
-t=in ................................................. lni ........................................... <zi ........
............. +i -n ................................ il- n t~i ii ~i t il- ~-=l--
il--il- ~i<zi (=ziii-) (+ +:- + ~--n- ii- =+i-- <zi zii=- ..................
................................... =+i ,ii ni- ~-=l-- il--il- t


~ii + t--i-i t--i-i
l<-i+ -in
-ii- nit
lni ~li+ii~l-l+- lni ~li+ii
l=i nl-n-i nl--t=in<i
Note: Proforma of certificate shall be changed according to latest Govt. order.







CERTIFICATE 2 (sii sz)

a-a s<zi + -4 fs n + fny ifa sii s +i ss (UPBC/GDBC)


t nili- l+i i-i t l+ iin-i +nii .................................................................
=z=zi i .....................................................................................l-i=i nin .......
............................................. -t=in ........................................ -n ........................
.... lni ............................................. -- <zi i +i ......................................
lzi il- + l+- t t il- -- <zi ni+ =i ~-=l-- il-i ~-=l-- -il-i
-ii lz ni + ln( ~i-ii ~lil-n. +- +i ~-=-i + + ~--n- ni--i i-- t
t ii nili- l+i i-i t l+ iin-i+nii ..............................................................
................ -+- ~lil-n +- +i ~-=-i . (~li=--i =i ..+-.+i c.+: ic
=ic l<-i+ l<=-. +: ,ii ii =ziili-) = ~i-zil<- -ti t
iin-i+nii ................................................................ -ii ~ii --+i li --
<zi + nin ..................... iin-i+nii ....................................... -n ..................
.......................... lni ................................... n =ini--i t-i t


~ii + t--i-i t--i-i
l<-i+ -in
-ii- nit
lni ~li+ii~l-l+- lni ~li+ii
l=i nl-n-i nl--t=in<i
aia ~ii i- < l+ -cc + ~- lz n + ln( il- nii sn oi, zoiz +
z-i- +i -i t~i ti-i ~iz+ t +il+ +inin + ~--n- ~i- in ~li i +i
~i-ii +i nii ~-n- -ti t






CERTIFICATE - 3 (izek.k i=&3)*
a-a s<zi n faiut + s / st (UPGD/GDSC/GDST/GDBC)
{au fn + fri+it zii sifia fu fn + iai/fsai faiut r)

4r sifia f+4i iai r f+ t/tat {4it + fsai/iai +i ai) ...................
...................................fsai/iai t/+o{4it +i ai)....................................
............................................. a-a s<zi + ni/zir ..................................
...... arutn .............................................fni ..................................... +
n faiut r aii t/+o {4it +i ai) ......................................................
..........sa fsai/iai s sia4i ifa r+ aa sa s t/+o {4it +i ai) ..
...........................................................+ iai/fsai uii-4a faiu +a r+


l<-i+ t--i-i lni nl-
-ii- i -in
<-in
nt
(lni nl- +i =in)

*fni faa ii fni faa zii fria s fni faa/u fta faa zii
sii si rt i-4 rin i ziioio uoisz/ata zoozz{II)/s f<ai+ is +t, zoo +
rita it f+4i i4ni+

aianii z. ~ii + ni-il-i +i -i ti-i -ilt( +il+ ~ii l-ti- ~t+ii i-ii --
<zi + it l-i- l+=i lin = --ii +i t -- --+ ni-il-i -- <zi + nn-ii:
l-i=i t













CERTIFICATE 4 (sii s4)
* FORMAT FOR MEDICAL CERTIFICATE
(To be obtained from a Chief Medical Officer or Medical Officer of a participating U.P. State Funded Engineering
Institute)

This certificate has to be submitted at the time of admission in the college allotted.

( To be filled in by the Candidate )
Name of Candidate: Age: Sex:
Category: Subcategory :
Father's Name:

L.T. M.I.
Height Weight Chest Abdomen
V
I
S
I
O
N
Colour Vision:
Without glass:
With glass:
History Operation Kockh's Colics B.P.

Seizures Asthma Piles Diabetes
E
X
A
M
I
N
A
T
I
O
N
Pulse Tonsil DNS Hernia

Pallor L.Nodes CSOM Hydrocele
Cardiovascular CNS

Respiratory GIT

Genitourinary Others
Is the candidate physically handicapped/Disabled: (Please tick) Yes / No
If yes, type of handicap/disability:
Type-I: Minimum 40% permanent Visual impairment
(Please trick P the type of handicap/disability) Type-II: Minimum 40% permanent Locomotors disability
Type-III: Minimum 40% permanent speech and
Hearing impairment
Any other finding:
Certified that the candidate is physically fit/unfit/temporally disqualified to pursue engineering studies




Signature of Candidate Signature of the issuing Medical Officer ( with
Official stamp)


CERTIFICATE 5 (sii ss)
UNDERTAKING BY CANDIDATE FOR MEDICAL FITNESS

I certify that I have no such physical handicap/disability which would hinder the pursuit of
studies in the courses in which I am seeking admission. If at stage it is found that I have a
physical handicap/ disability which would hinder the pursuit of studies in the courses in
which I am seeking admission then my admission will be liable to be cancelled. I will produce
medical fitness certificate from a C.M.O./C.M.S. at the time of my joining the institution
allotted by GBTU-counseling.


Date: Counter Signed by Father / Guardian Signature of the Candidate