UPSEE - 2014: Confirmation Page for Application Number :129401

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CONFIRMATION PAGE : UPSEE - 2014

(APPLICATION FORM FOR ADMISSION TO FIRST YEAR IN B.TECH. / B.PHARM. / B.ARCH. / BHMCT / BFAD / BFA/ LATERAL ENTRY (SECOND YEAR) IN B.TECH. AND B.PHARM)

Registration No. 129401

You have successfully submitted Application On-line. Kindly take the printout of this page. Paste your one passport size photograph and put your signature and thumb impression in the specified box. Send this form along with copy of Bank Challan (if fee paid by Bank Challan) to REGISTRAR (UPSEE-2014), UTTAR PRADESH TECHNICAL UNIVERSITY, I.E.T.CAMPUS, SITAPUR ROAD, LUCKNOW-226021, U.P. to reach latest by 5 PM, 07-04-2014. Place of Application Form FillingON LINE APPLICATIONS( OH) Candidate's Name SHAISTA ZAINAB Date of Birth 01/09/1997 Father's Name MOHD IMRAN BEG Category UPGE Nationality INDIAN Sub-Category UPGL Parent's Domicile U.P. Rural Weightage NO Gender FEMALE Qualifying Exam INTERMEDIATE Subjects in 10+2 PHYSICS, CHEMISTRY, MATHS, ENGLISH Qualifying Exam Passed From UTTAR PRADESH Year of Passing 2014 Seeking Admission For FIRST YEAR Courses Applied for 1st year admission B.TECH, B.TECH.(AG. ENGG.) Paper(s) to Appear PAPER-1 Choice of Exam Centres 1ST : MORADABAD, 2ND : BAREILLY, 3RD : MEERUT
DECLARATION

I certify that the particulars given by me in this Application Form are correct to the best of my knowledge and belief and any mistake / misinformation detected at the time of counselling or at any stage will result in the cancellation of admission. I have carefully read the Information Brochure of UPSEE 2014 and agree to abide by the terms and conditions laid down therein. Further, it is entirely my responsibility to prove the eligibility for admission to the 1st year of B.Tech. / B.Arch ./ B.Tech. (Agriculture Engg.) / B.Tech. (Bio Tech) / B.Pharma. / B.HMCT / BFAD / BFA / 2nd year of B.Tech. / B. Pharma course in respect of qualification and entitlement for admission against reserved category, if claimed, to the satisfaction of the UPSEE 2014. Further, I undertake that I will be visiting the web site (http://upsee.nic.in, http://www.uptu.ac.in) regularly for any information and I declare that all the information regarding UPSEE-2014 provided on these websites will be treated as served. Mailing Address: Name: Address: District: State: PinCode: Email ID: Mobile No.
SHAISTA ZAINAB MUGHAL PURA-1ST NEAR MASJID ABBASI GALI HAJI YUNUS MORADABAD UTTAR PRADESH 244001 AL.SALMAN.TRAVELS@GMAIL.CO 9411071615

Uploaded Signature

Uploaded Thumb Impression

Signature of the Candidate(Not in capital letters) Le ft Hand Thumb Impre ssion Signature of Parent /Guardian

Send this form along with copy of Bank Challan (if fee paid by Bank Challan) to REGISTRAR (UPSEE-2014), UTTAR PRADESH TECHNICAL UNIVERSITY, I.E.T.CAMPUS, SITAPUR ROAD, LUCKNOW-226021, U.P. to reach latest by 5 PM, 07-04-2014 . Details of Transaction(Punjab National Bank). Transaction ID.: 3818981 Amount: 507.01 Card Type : VISA/Mastercard

Date of Transaction 19/03/2014

Registra on No:

129401

Note : Please ensure that all the entries are filled up and transaction details of bank are available on the confirmation page, failing which your application is liable to be rejected.

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3/19/2014 8:30 PM