APPLICATION FORM 2019

(PRINTOUT OF ONLINE SUBMITTED APPLICATION FORM)

Print Date & Time: 19/05/2019 02:24                                                                                          

PM PRINT

Course Applied For B.E./B.TECH.

Roll No. WB500340
Application No. 5500340
Entrance Test-2019 Application No. 190310197463
Haryana Resident Category Yes
Category Tuition Fee Waiver Scheme of Haryana
Name as per Matriculation Certificate DEV KUMAR GUPTA
Gender MALE
Date of Birth as per Matriculation 02/03/2001
Certificate

Father/ Husband Name  RAJ KUMAR GUPTA

Mother Name JAI RANI GUPTA
Correspondance Address PLOT NO.12,STREET NO.6F,GANDHI NAGAR,GURGOAN
Qualifying Examination 10 plus 2 with Physics and Maths as compulsory subjects
Whether Appeared/ Passed? PASSED
Year of  Appearing/ Passing 2019
Telephone No. --
Mobile No. 7982482914
Email Address, if any devdk2208@gmail.com
Aadhar No/ Enrolment Id 643906324920
Application Fee (INR) 200
District Gurgaon
Area to which you belong Urban
Date and Time of Online Registration 19/05/2019 2:24PM
Important Instructions:
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1. The candidate should keep a copy of online filled application form for his/ her record.
2.The particulars of the candidate in the application form must exactly be the same as registered in the qualifying examination. In
case the candidate has submitted the incorrect information, the candidate is required to resubmit a fresh online application
form.
3.Admissions in TFW Category in B.E./B.Tech shall be made on the basis of All India Merit/Rank of JEE Main-2019.
4.Candidates applying to TFW category in B.E./B.Tech shall also take the print out of online filled application form and
deposit the same for verification purpose in the office of HSTES, Bays No. 7-12, Sector 4, Panchkula before the closing
date along with the attested copy of following documents:
i.Income Certificate issued by the competent authority (annual income of parents/ guardians should be less than ? 8.00 lakh
from all sources).
 ii.Haryana Resident Certificate (in case candidate has not passed/appeared in the qualifying examination from Haryana)
iii.DMC / Proof of appearing in qualifying examination in case candidate has passed/ appeared in the qualifying examination
from Haryana
iv.Proof of Application Fee deposition.
5.Candidate, if any, participating in counseling for admission in B.E./B.Tech as per his/ her category and also for TFW
Category in B.E./B.Tech, is required to deposit counseling fee separately.
6.In case of any query, candidate may contact to HSTES on Toll Free No. 1800 420 2026 or on e-mail
onlineadmissionhelp@gmail.com.
DECLARATION
I, hereby, declare that all the details mentioned in the application form are correct to the best of my knowledge and nothing has
been concealed off. I also understand that if any information is found incorrect, my candidature for admission process will be
cancelled at any stage. 

(Signature of Candidate)

Candidate Name: DEV KUMAR GUPTA

Roll No.: WB500340