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Application Form

The document contains the application details of Madhav Dang, who is applying for an undergraduate BTech program in Engineering. It includes personal information, contact details, tentative test locations, parent or guardian details, and payment information. The applicant confirms the accuracy of the information provided and acknowledges the terms and conditions of the admissions process.

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Madhav Dang
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4 views1 page

Application Form

The document contains the application details of Madhav Dang, who is applying for an undergraduate BTech program in Engineering. It includes personal information, contact details, tentative test locations, parent or guardian details, and payment information. The applicant confirms the accuracy of the information provided and acknowledges the terms and conditions of the admissions process.

Uploaded by

Madhav Dang
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 MADHAV DANG Application Number 126133397

Email ID tanudang35@[Link] Mobile Number +918193986411

Gender Male Date of Birth 10/01/2009 Nationality Indian

CATEGORY DETAILS

Category General Sub Category General

PROGRAM DETAILS

Program Level Undergraduation - UG Stream Engineering

Course BTech

Tentative Test Location Uttarakhand - Tentative Test Location Delhi - New Tentative Test Location Uttar Pradesh -
1 Dehradun 2 Delhi 3 Noida

PARENT OR GUARDIAN DETAILS FOR COMMUNICATION

Full Name PRAVEEN DANG

Email praveendanggd@[Link] Mobile Number 919634349271

ADDRESS DETAILS

Address Type Address 1 Address 2 City State Country Pincode

Correspondence Address 118 lunia mohalla near gopinath temple Araghar Uttarakhand India 248001

Permanent Address 118 lunia mohalla near gopinath temple Araghar Uttarakhand India 248001

PAYMENT DETAILS

Transaction Id 114172926033 Date 21/12/2025 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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