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Annexure I (Student Profile) 1

This document contains a student profile form for an Indian Institute of Technology that collects personal information such as name, date of birth, contact details, family information, educational qualifications, and category for a student admitted to an undergraduate course and discipline. The form requests details about the student's personal background, family, contact information, educational history, category and bank account details.

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Pravin Kaushal
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501 views1 page

Annexure I (Student Profile) 1

This document contains a student profile form for an Indian Institute of Technology that collects personal information such as name, date of birth, contact details, family information, educational qualifications, and category for a student admitted to an undergraduate course and discipline. The form requests details about the student's personal background, family, contact information, educational history, category and bank account details.

Uploaded by

Pravin Kaushal
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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Annexure- 1

INDIAN INSTITUTE OF TECHNOLOGY BHUBANESWAR


STUDENTS’ (UG) PROFILE ( For 20................. )

Roll No.(Office Use) School: Course admitted to: Discipline

Date of Joining:

A. PERSONAL
=== Registration No.:
JEE ==
/JAM All India Rank: Subject Code (As per JEE/
======
JAM /GATE :)
1. Full Name (in BLOCK letters as
as per JEE Allotment letter) (In English)
(All Certificates, Grade Card s& Transcript
\will be issued in this name only) (In Hindi)
2. Date of Birth: DD MM YYYY 3. Gender (M/F): 4. Blood Group: 5. Height(Cm):

6. Weight (Kg): 7. Nationality: 8. Category(Gen/OBC/SC/ST/PwD):


9. Caste: 10. OBC (Creamy layer/ Non Creamy Layer ): 11.BPL Category(If yes, supporting documents):
12. Religion: 13. State of 13. Mother Tongue:
Domicile:
14. ID Marks (if, any): 15. Presently reside at:
16. Name of the Branch(Bank): 17. Bank A/c No: 18. IFSC:
19. Mobile No. : 20. Passport No.: 21. e – mail id:
22. Aadhaar No.
B. PARENTAL INFORMATION:
23. Father’s Name
(full name in block letters)
Phone No.(with STD code): Mob: e – mail id:
24. Mother’s Name:
(full name in block letters Phone No.(with STD code): Mob: e – mail id:
25. Guardian: :
(full name in block letters Phone No.(with STD code): Mob: e – mail id:
Father: Mother: Guardian:
26. Occupation :
27. Income (IC to be attached):
C. RESIDENTIAL INFORMATION:
28. Present Address for Communication 29. Permanent Address

State: Pin: State: Pin:


D. EDUCATIONAL INFORMATION:
Examination Passed Medium of Board/ University/ Year of Discipline Specialisation Division/ Class % of Marks/ CGPA
(All Preceding Examinations) Instruction Institute passing
HSC (10 Level) or
Equivalent
H.S. (10+2 Level)
or Equivalent

* I do hereby declare that the information furnished by me is true to best of my knowledge, belief & based on records.

Full Signature of the Student & Date

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