Application form for VITEEE - 2017

Application No.

2017168965
Candidate Name : AKANKSHA SINGH
Date of Birth 17-01-1999 Gender FEMALE
Religion Hinduism Nationality Indian
Blood group O+ Mother Tongue Hindi
Community General/OC Nativity Uttar Pradesh
Mobile No. 8604587235 Email ID. akankshavns552@gmail.com
Parent name ASHOK KUMAR SINGH Hostel required No
Campus Choice Vellore Test city Varanasi
Mode of study Regular Medium of Instruction English
Qualifying Exam 12th Class Month & Year passing May - 2016
Exam Roll no. 5671131 Subject Code PCBE
Name of the Board 06-COUNCIL FOR THE INDIAN SCHOOL CERTIFICATE EXAMINATIONS
Permanent Address HIG-2 44 , JAMUNIPUR COLONY, BHADOHI, Bhadoi, Uttar Pradesh-221401
Address of the school BHADOHI, BHADOHI, Bhadoi, Uttar Pradesh-221401
DECLARATION
I solemnly and sincerely affirm that I am Indian National / PIO/OCI Holder 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 prospection and the management can claim all authority to
cancel my candidature / selection or admission as the case may be and I would have to forgo my seat and the fees.I will pay the required Tuition fees and the
Hostel fees within the stipulated time to ensure my admission in VIT University. 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 counseling or during the admission process, failing which I understand that I would have to forego my seat and the fees. I have read the
brochure and understood the contents in general and the method Equipercentile Equating in particular. I accept this method to be adopted for Merit List
preparation by VIT. I understand that all information related to VIT application form and VIT exam will be only sent through the valid mobile numbers as
provided by me in the same form. I am also aware of the refund policy that the counseling processing fee of Rs.10,000/- is non-refundable.

Signature of the candidate

Payment Acknowledgment Copy

Payment Option Made Netbanking/Credit/Debit Card

Application No. 2017168965

Candidate name AKANKSHA SINGH

Transaction No. 298875449

Application Fee Rs. 970.00

Transaction Amount Rs. 972.78 (includes banking service charge & service tax)

Transaction Date & Time 15-02-2017 14:39:29