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Application for Academic Year: 2011 Date: 15/06/2011 Application Code: 2011-RL-141-1530 Program Mode: Course Name: Student

name: Fathers/Husband Name: Mothers Name: Category: Date of Birth: Email: Landline No.: Mobile No. 1: Mobile No. 2: Nationality: Last Educational Qualification: Name of College: Year of Passing: Board/ University: Percentage: Exam. Passed: Score in any Other Admission Test: Name of Examination: Score: Year of Passing: Mailing Address: Address Line 1: Address Line 2: City: State: Country: Pin code: Permanent Address: Address Line 1: Address Line 2: City: State: Country: Pin code: Regular M.Tech + Ph.D. Joint Degree in Comp. Sc. & Tech. Mr. Bharat Bhushan Raj Kumar Saroj Bala General 13/12/1977 Gender: Male [email protected] 01262-210047 9729021111 Indian IGNOU 2010 MCA 0 61%

1395/28, Arjun Nagar, Behind Liberty Cinema, Opp Parkash Ceremony Hall Rohtak

124001 1395/28, Arjun Nagar, Behind Liberty Cinema, Opp Parkash Ceremony Hall Rohtak

124001

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