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Full Name
Date of Birth Religion Community Native State Landline No. Parent name Choice of Campus Qualifying Exam Exam Roll.No./Reg.No. Permanent Address Name of the School Address of the School DECLARATION I solemnly and sincerely affirm that I am an Indian National and that all particulars furnished by me in this application form are true and correct . I have not concealed any information. However, in the event of any information being found to be incorrect, fraudulent or untrue, either before or after the examination or after my admission to the programme, I understand that I am liable to face criminal prosecution and the management can claim all authority to cancel my candidature / selection or admission as the case may be and I would have to forego my seat and the fees. I agree to abide by the rules and regulations governing the examination as well as the rules pertaining to the refund of tuition and hostel fees contained in the brochure. I further undertake to submit all the required certificates as per the rule, either at the time of interview or during the admission process, failing which I understand that I would have to forego my seat and the fees. Date : Place : Signature of Parent / Guardian Signature of the Applicant
: KUSH KUMAR
: 10/03/1995 : Hinduism : General/OC : Gujarat : 06542 - 269891 : KETAN CHAWDA : Vellore : 12th Class :
: QUARTER NO 1144, SECTOR 6A,BOKARO STEEL CITY,Bokaro,Jharkhand,827006. : DELHI PUBLIC SCHOOL : SECTOR 4, BOKARO STEEL CITY, Bokaro,Jharkhand, 827004.
PASTE FIRMLY YOUR RECENT COLOUR PHOTOGRAPH OF GOOD QUALITY (SIZE 3.5 X 4.5 CM)
PLEASE WRITE YOUR NAME AND APPLICATION NO. ON THE BACK SIDE OF THE PHOTOGRAPH BEFORE AFFIXING.
Payment Acknowledgement Copy VIT ONLINE APPLICATION SALE Payment Option Made:-NetBanking / Credit Card / Debit Card. Bank Reference No.:0386486620 Applicant Name:KUSH KUMAR Contact No.:8986871502 Transaction No.:59698309 Application No.:2013047175 Transaction Date:20-12-2012 10:40:23
900.00
34.00
Note : 1.It is mandatory that the candidate should send the hardcopy of the application form to the address of the Director - UG Admissions,VIT University, Vellore -632014,Tamil Nadu. 2.Candidate should retain the photocopy of the application form.
To
Mode of Payment
Demand Draft ( DD ) Net Banking / Credit card / Debit card
: :
THE DIRECTOR - UG ADMISSIONS, VIT University, Vellore - 632014, Tamil Nadu, INDIA.
PLEASE INSERT THE APPLICATION FORM IN THE ENVELOPE IN SUCH A MANNER THAT THE BARCODE ON THE APPLICATION FORM IS NOT FOLDED.
1.Tick the box if you have enclosed the following documents: a. Completed Application Form with your signature. b. Completed Application Form with your parent's / Guardian's signature. c. Your color photograph (of size 3.5 cm x 4.5 cm) affixed on application appropriately. d. Have you entered your correct Date of Birth. 2.Retain a photocopy of the completed application form with you. 3.Send your application form to the VIT as mentioned on the address slip