RAMAIAH INSTITUTE OF TECHNOLOGY

1 Page No. 1(Autonomous INSTITUTE , affiliated to Visvesvaraya Technological University, Belgaum)VIDYA SOUDHA(Recognized by Govt. of Karnataka, AICTE, accredited by NBA)Subject to Bangalore Jurisdiction NAGAR, , BANGALORE -560 054 Phone Nos : 080-23600822,23606934,23606936,23607902 WebSite : Email : ADMISSION FORMP hone No. (with Code)Permanent Address"Outcome Based Education " software by USNFull Name of Applicant in Block Letters (As per PUC Marks card):BranchFOR FOR THE YEARKEA/CET / comedk Reg.

2 ClaimedCategory AllottedFirst NameMiddle NameLast Name/Surname/InitialsDate of BirthGenderBlood GroupAdmission Order No. and dateIssued DateDate of AllotmentLast date of joiningCollege CodeAdmission TypeSemesterTermAdmission based onCET Fees PaidReligionCasteSub-CasteCurrent AddressCityStatePincodeCountryCityStateP incodeCountryMobile No. (with Code)Emergency Contact NumberEmail IDDomicileAreaPlace of BirthState of BirthCountry of BirthBirth place PincodeNationalityNRIM other TongueDisability / HandicapType of disabilityEconomically BackwardRAMAIAH INSTITUTE OF TECHNOLOGYSPECIMEN COPYPage No.

3 2(Autonomous INSTITUTE , affiliated to Visvesvaraya Technological University, Belgaum)VIDYA SOUDHA(Recognized by Govt. of Karnataka, AICTE, accredited by NBA)Subject to Bangalore Jurisdiction NAGAR, , BANGALORE -560 054 Phone Nos : 080-23600822,23606934,23606936,23607902 WebSite : Email : ACADEMIC DETAILSPUC / 12th Details'C' PARENTS DETAILSF ather DetailsAddress"Outcome Based Education " software by INSTITUTE OF TECHNOLOGYS chool/College NameBoard NameYear of PassingSchool/College StateMarks Card of InstructionSchool/College TownRoll/Reg.

4 NoSchool/College CountrySubject NameMaximum Marks Minimum MarksObtained MarksENGLISH10035 KANNADA10035 PHYSICS10035 MATHEMATICS10035 CHEMISTRY10035 SANSKRIT10035 Total600210 Aggregate %PCM %PCM MarksName of FatherIf claiming under OBC/GOVT SNQ as per annual income certificateYesAnnual IncomeOccupationPAN NumberMobile No No No.(with Code)Email IDCityStatePincodeCountrySPECIMEN COPYPage No. 3(Autonomous INSTITUTE , affiliated to Visvesvaraya Technological University, Belgaum)VIDYA SOUDHA(Recognized by Govt.)

5 Of Karnataka, AICTE, accredited by NBA)Subject to Bangalore Jurisdiction NAGAR, , BANGALORE -560 054 Phone Nos : 080-23600822,23606934,23606936,23607902 WebSite : Email : DetailsAddressEmail Score card for Architecture CourseYESYES2 Stamp size photosYESYES310th Marks SheetYESYES412th Std. Marks Certificate and Income Certificate (If claiming under SC/ST/1/2A/2B/3A/3B category)YESYES6 Certificate from the indian embassy in proof of NRI statusYESYES7 KEA/ comedk /UGCET 1+3 YESYES8 Migration Certificate(if studied other than PUC of Kar.

6 YESYES9 Passport and Visa CopyYESYES10 Study Certificate 7/10 YearsYESYES11 Transfer Certificate / College Leaving CertificateYESYES"Outcome Based Education " software by INSTITUTE OF TECHNOLOGYName of MotherAnnual IncomeOccupationPAN NumberCityStatePincodeCountryMobile No No.(with Code)SPECIMEN COPYPage No. 5(Autonomous INSTITUTE , affiliated to Visvesvaraya Technological University, Belgaum)VIDYA SOUDHA(Recognized by Govt. of Karnataka, AICTE, accredited by NBA)Subject to Bangalore Jurisdiction NAGAR, , BANGALORE -560 054 Phone Nos : 080-23600822,23606934,23606936,23607902 WebSite : Email : BY THE PARENT / GUARDIAN1.

7 If there is any false information/fake certificate or any forgery in the Particulars/certificates/documents submitted by my ward to the authorities of MSRIT/University, my ward's admission may at once be cancelled and necessary action may be taken2. I agree to the applicant's admission to the Institution. I shall be responsible for the payment of all fees and shall be responsible for my ward's conduct and good behavior during the course for the entire period till he/she gets the degree. There is no necessity for MSRIT to inform further regarding these Verified SIS paid charge Accounts SectionAdmitted "Outcome Based Education " software by INSTITUTE OF TECHNOLOGYP lace : DECLARATION BY THE STUDENT1.

8 I declare that particulars and information furnished on pages 1 & 2 are fully I declare that I have Passed the 10+2 Examination conducted by Gfd Board / University Gfd state during 2014 and secured of marks in aggregate3. If there is any false information/fake certificate or any forgery in the particulars / certificates / documents submitted by me to the authorities of MSRIT /University, my admission may at once be cancelled and necessary action may be I do understand that, my admission at MSRIT is provisional and subject to approval of the VTU, I Promise to abide by the rules and regulations of the Institution and the University, and I can be subjected to disciplinary action, if need arises.

9 And also I can be dismissed from the college, if I am found not obeying the rules and regulations6. I agree to adhere to Rules and Regulations, Scheme of study and Examinations of the Autonomous INSTITUTE , affiliated to Visvesvaraya Technological University, I do not indulge in ragging in any of the I do know that the mobile phones are banned in the college campus. I do know that, I should come with decent dress to the college. If I fail to do so suitable action may be taken against : Signature of the Candidate Place : Date : Signature of the Parent.

10 To SIS No dt SPECIMEN COPYPage No. 6(Autonomous INSTITUTE , affiliated to Visvesvaraya Technological University, Belgaum)VIDYA SOUDHA(Recognized by Govt. of Karnataka, AICTE, accredited by NBA)Subject to Bangalore Jurisdiction NAGAR, , BANGALORE -560 054 Phone Nos : 080-23600822,23606934,23606936,23607902 WebSite : Email : TO FRESHERS FOR THE ACADEMIC YEAR 2016-2017 INSTRUCTIONSThe following instructions are to be followed by you before filling the Application Form.