THAPAR UNIVERSITY , PATIALA

Established u/s 3 of the UGC act,1956 vide Notification No. F.9-12/84-U.3 of Gol

SESSION 2011-2012

APPLICATION FORM FOR ADMISSION TO PG PROGRAMMES

Important instructions: Please read Prospectus available on www.thapar.edu carefully before filling each item of the Application Form

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Application No. :-

25909
Entrance Test Result (AIEEE-2011) candidates must attach photocopy of admit card Roll No : 25909 All India Rank :1400085 (To be Filled by Office)

Name of the Programme applied for: ME (Part Time) - MEP

Discipline applied for [ME/MTech/MPhil/MSc(Phy)/MSc(Chem)/MSc(Math & Comp) candidates only): PRODUCTION & INDUSTRIAL ENGINEERING DETAILS OF DEPOSIT OF FEE. Transaction Transaction Transaction Amo Date/DD Detail/DD No./DD No. unt Date Detail ONLINE 1000. 387193 21-05-0011 FILLED 0

Name (in the block letters & as entered in qualifying exam. 1. certificate) NITIN SETHI Gender : Male Father's Name(as entered in qualifying exam.certificate): 2. SUBHASH CHANDER SETHI Q Occuption: Designation: Dept: 3. Mother's Name(as entered in qualifying exam. certificate) : 4. Guardian's Name : * Hostel Required : No 5. Contact Details Correspondence Permanent Address : Address : Country : INDIAN 85 DYAL SINGH City : COLONY State :58 City :KARNAL Pin : State :58 Pin :132001 Telephone No. Office No. Residence No. (with STD Code) Mobile E-Mail: No. 9812430015

PASTE A RECENT PASSPORT SIZE PHOTOGRAP H AND GET IT ATTESTED

6. Date of Birth(as per Matric certificate):07-01-1986

7. Has your father/mother studied at TU : No 8. If Yes,Registration No. 9. Total Monthly Income : 10 Nationality : INDIAN . 11 Name of the Qualifying Exam (10+2/diploma/graduation/PG) : . 12 Name of the State from where passing/appearing in qualifying . exam : OTHER 13 Details of Examination . % of Marks/ Exami Year of School/ Universit Grade nation Passing College y/Board Point Obt./A waited 14 Category : GENERAL(OPEN) . For candidates seeking admission in UG programmes on the basis 15 of AIEEE-2011. Enter your option by giving your order of preference ("First" for the most preferred next and admission . discipline "Second" for thepreferencesoison. Candidates will not be considered forhere under in those disciplines for which column for order of left blank. Preferences once exercised will not be changed
under any circumstances)

Name of the Degree :

Program Prefere Branch Name Name nce ME (Part PRODUCTION & INDUSTRIAL 1 Time) ENGINEERING 17 Preference of Center (Patiala,Delhi) . SNo CENTER PREFEREN . DESCRIPTION CE
UNDERTAKING (a) I declare that I have not been debarred from joining any educational institution or rusticated from the Institution/University/Board last attended. (b) I declare that all the statments made in this application are true to the best of my knowledge and belief.I clearly understand that if any of the statement is subsequently found to be untrue,my admission to University would stand cancelled. (c) I have read the information Prospectus and Instructions incorporated therein carefully. (d) I have satisfied myself that I fullfill Father's/Guardians Undertaking (Not required for Candidates applying for PhD Programme) My son/daughter/ward NITIN SETHI is seeking admission with my consent and in the event of his/her being admitted to the Thapar University,Patiala I will be personally responsible for(1) his/her good conduct and behaviour during his/her stay at the

the minimum educational qualifications, physical and medical standard and that my admission be treated as cancelled if found deficient in these standards. (e) I agree that admission may be granted to me on the terms and conditions stated in the latest edition of the Prospectus and Instruction of University or such modifications thereof as may be made by the authorities. (f) I promise to abide by the rules and regulations of the University as applicable from time to time.I undertake that so long as I am a student of the University,I will do nothing either inside or outside the University that will interfere with its orderly working and discipline. (g) I am aware that ragging is totally banned, if found guilty of ragging, I would be liable to be punished as per rules and regulation of the University/law of land. Place:________ Date: ________ the Applicant Signature of

University (2) return of the books issued to his/her fees, Hostel Mess and Canteen dues and other expenses incurred on campus and educational tours,expenses to cover any breakage or damage of University property. I also agree that he/she will submit to the discipline of the University.I am aware that ragging is totally banned and agree to abide by the punishment meted out to my ward in case he/she is found guilty of ragging.

Place:___________ Date:__________ Signature of the Father/Guardian

NOTE: Incomplete Applicant will be rejected. List of documents to be attached with application form: I. General category : No document is required. II. Backward Class Category : A copy of reservation certificate as per specified format. Income certificate of parents III. Sports Category : A copy of the Sports gradation certificate. IV.SC/ST, Physical Handicap Category : A certificate based on which reservation is sought. FOR OFFICE USE ONLY : Discipline offered to the candidate as per his/her rank: I Counselling II Counselling (i) Category___________________ (ii) Discipline alloted ______________ Signature of Chairman (i) Category______________ _____ (ii) Discipline alloted ______________ Signature of Chairman

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Disclaimer : While every care has been taken to ensure accuracy of the above data the same is subject to re-verification/correction at appropriate time.
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