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Sant Longowal Institute of Engineering and Technology: Print Form

The document appears to be an application form for admission to the Sant Longowal Institute of Engineering and Technology, and contains general details about the applicant such as name, father's name, date of birth, category, education details, contact details, and payment details. It also includes spaces for signatures, photographs, and thumb impressions. The applicant is seeking admission to a 3-Year Integrated Certificate-Diploma program and has provided information about their 10th standard qualification and contact information.

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Vikash Kumar
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78 views1 page

Sant Longowal Institute of Engineering and Technology: Print Form

The document appears to be an application form for admission to the Sant Longowal Institute of Engineering and Technology, and contains general details about the applicant such as name, father's name, date of birth, category, education details, contact details, and payment details. It also includes spaces for signatures, photographs, and thumb impressions. The applicant is seeking admission to a 3-Year Integrated Certificate-Diploma program and has provided information about their 10th standard qualification and contact information.

Uploaded by

Vikash Kumar
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
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Print Form

Sant Longowal Institute of Engineering


and Technology
Tel: +917347205649
01672-253178,01672-253179

GENERAL DETAILS

Form No.: 201772 Quota: Other State

Candidate Name: VIKASH KUMAR

Father's Name : BAIJU SAH

Mother's Name : KOMAL DEVI

Date of Birth : 25 May 2000 Gender : Male


Signature of the Candidate
OBC (Physically
Category : NAD ID No NAD ID
Handicapped: No)
Indian (Religion : Aadhar Card No -
Nationality: Identity Status:
Hindu) 703954244386
Thumb impression of the
Annual Income: Below 2.5 Lacs - Question Paper Language: Hindi Candidate
Education Details
Admission Sought For : 3-Year Integrated Certificate-Diploma (ICD) SET-I
Educational Qualification : 10th Result Status : Passed(48.8)
Name Of Industry/Department : Experience [Years] :
Contact Details
Telephone No.: Email ID: [email protected]
Mobile No.1: 9798893025 Mobile No.2:
Address Details

Mailing Address: PAIGHAMBARPUR KOLHUA , KOLHUA PAIGHAMBARPUR , Muzaffarpur , Bihar, 843108

Permanent Address: PAIGHAMBARPUR KOLHUA , KOLHUA PAIGHAMBARPUR , Muzaffarpur , Bihar , 843108

Centre Choice

1st: Muzaffarpur 2nd: Darbhanga 3rd: Patna 4th: Ranchi

Payment Details
Fee Type : Registration Status Paid
Mode of Payment : Online Date of Payment : Apr 16 2019 1:48PM
DECLARATION: I hereby declare that all the particulars stated by me in this application form are true to the best of my knowledge and belief. I have
read the information brochure of SET-2019 and I shall abide by the terms and conditions therein. Also it is entirely my responsibility, at the time of
counselling to prove my eligibilty for admission to ICD/Diploma/Degree/PG/Ph.D. course in repects of qualification and entitlement for admission
against reserve category, if claimed, to the satisfaction of the institute. Further, in the event of suppression or distortion of any fact made in my
application form, I understand that my candidature is liable for cancellation. I also understand that the decision of the admission committee of SLIET
regarding my admission is final and I shall abide by the decision. Further, if admitted, I promise to abide by the rules and norms of the intitute.
Self Attested Photo
Signature of the Candidate Left Thumb Impression Right Thumb Impression Guardian Signature
of Candidate

   

Note: Take a print out of this form. After signing and putting your one photograph and  thumb impression on this form.Kindly send it through reg. post
/ speed post only within a week of registration, addresed to Chairman, SET-2019, SLIET, Longowal (Sangrur), Punjab 148106.

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