Karmaveer Kakasaheb Wagh Education Society’s

KARMAVEER KAKASAHEB WAGH INSTITUTE OF

ENGINEERING EDUCATION & RESEARCH
Hirabai Haridas Vidyanagari, Amrut Dham, Panchavati, NASHIK-422 003, (Maharashtra).
Ph. No.(0253) 2516671,2512876,Fax-2511962,2621183, 2518870
Mail: kkwcoe_nsk@sancharnet.in, kkwe_office@dataone.in WEBSITE: www.kkwagh.org

APPLICATION FOR ADMISSION TO FIRST YEAR MASTER OF ENGINEERING

COURSE OF UNIVERSITY OF PUNE FOR THE YEAR 2009-2010 Paste the
Date of Reporting:_____________ Photograph inside
the box only
Institute PR No.
Don’t Staple or Pin
Course for which admission is sought: ME Production (Manufacturing & Automation)/
the photograph
M.E. Civil(Structure) / M.E. Electrical (Control System) Engineering
{√ Tick mark in appropriate box}

1. Name of the student: ___________________________________________________________________

2. Address
Correspondence Address
____________________________________________
____________________________________________
____________________________________________
____________________________________________
PIN___________Ph.No. R. _____________________
PP. _____________________
Mob. _____________________
E-mail ID:
Permanent Address (Where father/mother Stay)
________________________________________
________________________________________
________________________________________
________________________________________
PIN_____________ Ph.No. R- _______________
PP. ________________
Mob. _________________
E-mail ID:

3. Date of Birth: ________________Age: ________ Birth Place & District: _________________________

{√ Tick mark in appropriate box, as applicable}

a) Male Female

b) Open SC ST OBC Others (Write Category)

c) GATE Non GATE

d) Are you a Sponsored Candidate Yes/No _______________________

If “Yes”
4. Details of Post held _____________________________________________________________________
Organization ___________________________________________________________________________
Work Experience: Industrial - Year ______________ Month ________________
Teaching - Year ______________ Month ________________

5. a) Details of Qualifying Examination:

Degree % Of Marks
Year of Passing Branch University Remarks if any
Obtained Obtained
b) Details of GATE Score on the basis of which admission is being sought.
Year ____________ Branch ___________ Percentile ____________

(Student to keep three sets of attested Xerox with them for subsequent use)

DECLARATION
1) I hereby declare that I have carefully read and understood the instruction and particulars supplied to me
by the Institute and all entries filled by me in this form are true to the best of my knowledge and belief.

2) I will strictly adhere to the rules, regulations and discipline of the Institute
Place: NASHIK
Date: ____________ Signature of the student

Attested copies of certificate Enclosed:

{√ Tick mark in appropriate box, as applicable}

1. Qualifying Exam Certificate 5. Caste Certificate

2. GATE Score Card 6. Migration Certificate

3. Mark List Of Qualifying 7. Work Experience Certificate

Examination
4. Copy of Transfer Certificate 8. Sponsorship Certificate

Verified by
Scrutiny Officer

Sign. of Admission I/c Student Section Admitted / Not Admitted

_______________________________________________________________________________________
(Official Use) (Students has to fill this column)
HOD’s Remark: _____________________________
1000 X
Sign. of HOD 500 X
100 X
Provisionally admitted /Not admitted __________ 50 X
20 X
10 X
Admission I/C / Student Sect. PRINCIPAL 5 X
2 X
1 X
Accounts Remarks –
Total Rs.
Fees Paid Rs._____________
Fee Dues: ____________ D.D. No. ______________ Date: _____________
Receipt No. ____________ Date ___________ Bank: ______________________ For Rs. _____________
D.D. No. ______________ Date: ___________ Bank: ______________________ For Rs. _____________

Cashier’s Signature