Birth Certificate and Competent Authority

RUSTAMJI INSTITUTE OF TECHNOLOGY
BSF Academy, Tekanpur, Gwalior – 475 005 (M.P.) Tel.:- [phone], Fax [phone] e mail: [e-mail]
------------------------------------------------------------------------------------------------------APPLICATION FORM FOR ADMISSION IN B.E. -2013 (FOR BSF/CPO’s WARDS ONLY) RJIT Roll No. (For RJIT use only)
1. Name in Full (In Block Letters) (As per 12th Marksheet) Father’s Name (In Block Letters) Mother’s Name (In Block Letters)

JEE Main Roll No. (To be filled by candidate) Affix your recent passport size colour photograph attested by Unit/HQ Comdt. or his authorized Signatory

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Contact No. (Telephone No.) (Mob No.)

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E-mail ID (a) Candidate ___________________ (b) Father ____________________ Identification Mark of Candidate ____________________________________________ Date of Birth D D M M Y Y Y Y (As per 10/12 Marksheet) Sex Tick √ Male Female

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Organization (BSF/CPO’s) ____________ Unit____________ (only BSF employees) Rank (only BSF wards) : Wards of Officers/SO’s/OR’s/Widows Religion _____________Category Tick √ Gen SC ST OBC

If secured Gold Medal in National Level Games and Sports Meet Tick √ Yes No

If, yes then attach appropriate certificate issued by the competent authority. 13. 14. If physically handicapped Tick √ Yes No

If, yes then attach appropriate certificate issued by the competent authority Are you a Resident of J & K? Tick Yes No √ If, yes then attach appropriate certificate issued by the competent authority. Are you a Kashmiri Migrant? Tick Yes No √

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If, yes then attach appropriate certificate issued by the competent authority. 16. Academic Qualifications Examination School/College Board Subject Year of Passed Passing (Class 10th Onwards)

Percentage of Marks

Last academic qualification obtained (with year)

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Branch preference (To be filled in order of choice) (a) Electronic & Communication Engg (ii)