Step iii : online application form –

K.J.Somaiya Institute Of Engineering & Information Technology
Sion, Mumbai. Pin – 400 022
(AICTE Approved – Affiliated to Unversity of Mumbai) Online Application Form for Admission to First Year Engineering Course 2013 – 2014
Admitting Center : KJSIEIT, Sion, Mumbai
Type of Seat :
Space for Office Use

APPLICATION NO.:

FORM NO.: ________________

Specimen Signature

1. Particulars of the Applicant
a) Name :
b) Mother’s Name :
c) Address for Correspondence :
d) Pincode :
e) Telephone No. : f) Mobile No. :
g) Date of Birth : h) Place of Birth : i) Gender : j) Religion :
k) Category : l) Nationality : m) Email : n) Blood Group :
o) Aadhar No. :
p) Amartya Insurance Details :
Name of the Student :
Age : Yrs.
Name of the Earning Parent / Legal Guardian :
Relationship with Student :
2. Particulars of the Parent / Guardian
a) Name :
b) Address for Correspondence :
c) Pincode :
d) Occupation : e) Designation :
f) Telephone No. : g) Mobile No. :
h) Email : i) Annual Income: Rs. (approx.)
3. Examination
MT-CET-2013 Seat No. :
MT-CET-2013 Mathematics Physics Chemistry Total
Max Marks 100 50 50 200
Marks Obtained
HSC Mathematics Physics Chemistry PCM Total PCM %
Max Marks N/A N/A N/A N/A N/A%
Marks Obtained N/A N/A N/A N/A
SSC Mathematics
Max Marks
Marks Obt.
4. Details of institution where studied and examination passed. Fill up whichever applicable
Examination Month & passing year Name of Board Max Marks Marks Obtained % of Marks
SSC / Equivalent %
HSC / Equivalent
N/A N/A N/A N/A%
5. JEE – Main Score (Optional)
Max Marks in PCM : N/A Year of Passing : N/A
Marks Obtained in PCM: N/A All India Rank : N/A
6. Diploma Examination Details (Optional)
Branch : N/A Pattern : N/A
Max Marks : N/A Board : N/A
Marks Obtained : N/A Year of Passing : N/A
   
 
   
Date  :____________________ _________________________________
  (Signature of Candidate)
Place :____________________  
DECLARATION BY THE PARENT / GUARDIAN
The particulars furnished by my ward are true and correct.  
   
Date  :____________________ _________________________________
  (Signature of Parent / Guardian)
Place :____________________  

APPLICATION NO.:

Attested True Copied of following documents required while submitting the application form:

Leave a Reply

Your email address will not be published. Required fields are marked *