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Application Form

Anisha Jain, an Indian female applicant born on 27/08/2008, has applied for an undergraduate BTech program in Engineering with application number 126180932. She has selected West Bengal as her test locations and has provided her correspondence and permanent address in Kolkata. The application includes a payment of INR 2000.00 and a declaration confirming the accuracy of the provided information.

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anishajain850
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6 views1 page

Application Form

Anisha Jain, an Indian female applicant born on 27/08/2008, has applied for an undergraduate BTech program in Engineering with application number 126180932. She has selected West Bengal as her test locations and has provided her correspondence and permanent address in Kolkata. The application includes a payment of INR 2000.00 and a declaration confirming the accuracy of the provided information.

Uploaded by

anishajain850
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

APPLICANT DETAILS

Name ANISHA JAIN Application Number 126180932

Email ID anishajain850@[Link] Mobile Number +916291473956

Gender Female Date of Birth 27/08/2008 Nationality Indian

CATEGORY DETAILS

Category General Sub Category General

PROGRAM DETAILS

Program Level Undergraduation - UG Stream Engineering

Course BTech

Tentative Test West Bengal - Tentative Test West Bengal - Tentative Test West Bengal -
Location 1 Kolkata Location 2 Asansol Location 3 Siliguri

PARENT OR GUARDIAN DETAILS FOR COMMUNICATION

Full Name Abhishek Jain

Email jainabhi04@[Link] Mobile Number 919434026762

ADDRESS DETAILS

Address Type Address 1 Address 2 City State Country Pincode

Correspondence 221/2B, Bagmari Road, Primarc Anukul, Flat 6A West


Kolkata-700054 Kolkata India 700054
Address block-2 Bengal

221/2B, Bagmari Road, Primarc Anukul, Flat 6A West


Permanent Address Kolkata-700054 Kolkata India 700054
block-2 Bengal

PAYMENT DETAILS

Transaction Id 114331862478 Date 28/02/2026 Amount INR 2000.00

DECLARATION

• I hereby confirm that the above-mentioned details are correct. I declare that all the
particulars stated in this application form are true to the best of my knowledge and belief. I
have read and understood all provisions of the admissions process and agree to abide by them. I
also affirm that I fulfill the eligibility requirements for the program(s) applied. I
understand that I can only apply once for each group. In case I apply more than once, only
one of my applications will be accepted, and the application and entrance test fees remitted
will not be refunded.
• If it is found at a later stage, during active verification, that I have provided false, incorrect
or untrue information w.r.t educational qualifications, marks, nationality, etc., or submitted an
eligibility document from an unrecognized board or university, my admission or degree will
be canceled without notice, with forfeiture of all fees paid.
• Jurisdiction for disputes, if any, shall be at the Udupi Court, Karnataka, India only.

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