3. date of birth

App. No......................................... Year ................................

Course Applied for B.Tech / M.Tech / MBA :

Branch Preference 1 ................................................................................................



AFFIX PHOTO

(Filling of the form does not guarantee admission in the Institution)(The form is to be filled by the candidate in his/her own handwriting in BLOCK LETTERS only)

1. Name in Full : .....................................................................................................................................................

2. Father's Name : ..................................................................... Mother's Name : .................................................

3. Date of Birth :

4. Permanent Address :...........................................................................................................................................

City : ........................ Pin Code : .............. Phone (with STD) : ...................... Mobile No.: ...........................

5. Correspondence Address : .................................................................................................................................

City : ........................ Pin Code : .............. Phone (with STD) : ...................... Mobile No.: ...........................

Place of Residence : Rural Urban Aadhar Card No.

6. Nationality : .................................................... Email ID (Student) : .....................................................................

7. Details of EAMCET/ICET/PGECET/ECET/GATE / Other Competitive Examination (if applicable) Please Specify .........................

Roll No. Rank Score

8. Category : General SC ST OBC EWS PH Minority Others .......................

9. Payment Detail (DD/Cheque/Cash) ...........................................................................................................................................

10. Admission Category :- A B

11. Eligibility for Scholarship by Government (RTF) YES/NO

-----------------------------------------------------------------------------------------------------------------------------------------------------

Gender : Male Female

(For Office use only)No. ..............................................

Received on .........../........../.......... Other Requirements ........................................................................................................................

................................................................................................................................................................................................................

Undertaking enclosed [Y] [N]

Documents not attached1/2/3/4/5/6/7/8/9/10/11

12. Details of Previous / Qualifying Examination (Attached attested Mark Sheets) :

Name ofExam.

Name of Institution Board / University Year ofPassing

MarksObtained

Max.Marks

% Marks/CGPA

X

XII

Diploma

Gradu.

P.G.

Others

13. Fee Details

S.No. Duration of the course(PG/ UG) 2/4 Years

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

14. Name of Father ............................................................... Name of Mother .......................................................................

Occupation of Father ...................................................... Occupation of Mother ............................................................

Office Address................................................................. Office Address .........................................................................

Mobile No. ..................................................................... Mobile No. ............................................................................

Email ID .......................................................................... Email ID ...................................................................................

15. Name of Local Guardian (if any) ......................................... Relationship.................................................................................

Occupation of Guardian ...................................................... Address ..........................................................................................

Mobile No............................................................................. Email ID .........................................................................................

16. Annual Income of Parents/Guardian (Choose the appropriate Income Slab)

Below 1 Lakh 1-3 Lakhs 3 Lakhs and above

Tuition Fee(Per Year) RTF

University Fee

Examination Fee

Activity Fee Rs.1,000/-*

Convocation/Alumni Fund Rs.1,000/-*

Tool kit (In the 1st year only) Rs.4,500/-*

Blazer /Dress Rs. 5,500/-*

Books Rs.16,000/-*(For 4 Years)

Excellence Fee Rs.10,000/-*

Any other Fee

Rs.

As per norms

As Per JNTUK Norms

Rs.

Rs.

Rs.

Rs.

Rs.

Rs.

Rs.

*Not Mandatory

UNDERTAKING BY THE STUDENT/PARENT/GUARDIAN

1) Thereby certify that the particulars are correct and also agree that admission may be granted on the terms, conditions,and rules of the Institute.I Understand that admission will be cancelled and fee paid by me will be forfeited if any ofthe particulars given by me at the time of admission or later are found to be incorrect, concealed or false.

2) I agree that Director/Principal in case of the Institution or the competent authorities and their decision in all matterconcerning my admission,studies,discipline and conduct will be final and binding upon me.

3) I understand that the student's association, active or passive, with any unlawful organization unions etc,is forbiddenand I shall not have any objection if I am expelled or rusticated from the Institute due to my participation in anyunion/unlawful activity or any other activity which violates code of conduct of the Institute.

4) I understand that the consumption of alcohol, drugs or any other intoxicant within the Institute/Hostel premises is forbidden.5) I am aware that as per Hon'ble Supreme Court orders, ragging in any form whatsoever is totally banned and criminal

FIR will be lodged in case I am involved in the case of ragging. This will result in any rustication from the Instituteand I will not be able to take admission anywhere in India.

6) I hereby declare that I was never involved or punished in case of indiscipline during my school or college career.There is no inquiry pending against me with the school/college/police/other authorities of the state to which Ibelong or resided in any other state at any time.

7) I confirm that I have submitted the original certificates to the Institute on my own will and shall be returned to meafter the same are verified by the Institute upon my clearing all dues at the end of my studies. In case, I discontinueor leave the Institute in between the duration of the course I shall have to pay the fee for the remaining duration ofthe course. Failing to do so the Institute can take any legal action against me

8) I agree that if any component of fee is revised by the competent authority, the enhanced amount if any shall bedeposited within two weeks of issue of such notification, I understand that the fee has to be paid in advancesemester wise.

9) I Understand that I have to undergo mandatory practical training for specified periods in accordance with therelevance of my being placed in an industrial organization within or outside the state in which institute is located,for such practical training. I will not have any objection of my being placed so. The Institute shall not be heldresponsible in any way for any mishap that may occur to me during my tenure in the Institute/Hostel or during thetraining outside the Institute.

10) I hereby agree to make all the necessary arrangements for the Boarding and Lodging, if hostel accommodation isnot available or availed.

11) I am aware that my name will be stuck off from the rolls of the Institute if I fail to pay fee on time, remain absentcontinuously for a period of 10 days without information or behave in a manner subversive to the discipline orcommit grave misconduct, such as ragging or indulge in any activity which may bring disrepute to the Institute.

12) I am aware that the use of mobile phones in the Institute premises is banned. In case I violate this, strict action willbe taken against me as per the disciplinary rules of the Institute.

13) I shall acknowledge that my testimonials and photographs taken during institute functions/events are deemed to bethe property of the institute. Institute has the right to the usage of students photograph in the Institute website,brochure and other related publications and materials.

14) I understand that I have to follow all University/Institute /Government of A.P. Rules and Regulations in the subjectsof attendance, examination, discipline and in all other matters.

15) I will report for registration as per the schedule announced by the University/Institute failing which my admissionwill stand cancelled without any intimation from the University/Institute.

16) I understand that in the event of breach of any of the aforementioned conditions of the undertaking my admissionwill stand cancelled without any obligation on the part of the Institute to issue show cause notice. In such case thefee other than the refundable amount shall stand forfeited.

17) In case, I avail the Institute transport facility, the Institute is not responsible for any mishap or discontinuation of busservice. I shall be availing the transport facility at my own risk and peril. The necessary undertaking in this regardshall be submitted as and when I start availing the transport facility.

18) I agree that I have taken admission in Lingayas Institute of Management and Technology after understanding all theadmission procedures of the Institute.

19) I would be attending the classes regularly as I am aware that 75% attendance is compulsory in every subject/coursein every quarter.

20) The use of Laptop is compulsory andi would be using laptop regularly during the full duration of course.21) Refund policy is governed as per the process given in the brochure or given on the institution website. I have read&

understood the FEE REFUND POLICY of the institute.

Signature of Parents/Guardian Signature of Student

DECLARATION

I hereby solemnly confirm that I have read the Institute Prospectus and have clearly understood the points mentioned in the

undertaking. I shall abide by the rules and regulations of the University/ Institute as mentioned in the prospectus and also the

changes which may be notified from time to time. I further confirm that the information given in the application form given by

me is correct and true to the best of my knowledge.

Signature of the Candidate

I shall abide by the conditions of the undertaking duly signed by my ward.

Signature of Parent/Guardian

Place :...................................

Date :..................................

Address: ................................................................................................................

...................................................................................................................

LINGAYA'S GROUP OF INSTITUTIONS

Lingaya's Vidyapeeth,Faridabad

(Approved by MHRD / AICTE/ PCI/BCI / COA / NCTE / Govt. of India

u/s 3 of UGC Act 1956)

Lingaya's Lalita Devi Instituteof Management & Sciences,

Mandi, New Delhi(Approved by Govt. of NCT of Delhiand Affiliated to GGSIP University)

Lingaya's Institute ofManagement & Technology,Near Nunna, Vijayawada (A.P.)

(Approved by AICTE & Govt. of A.P.and Affiliated to JNTU)

Lingaya's Academy,Saket, New Delhi.

Lingaya's Public School,Faridabad

(Affiliated to CBSE & Approved byGovt. of Haryana)

Lingaya's Institute ofHealth Sciences,

Faridabad(Approved by Indian Nursing Council& Govt. of Haryana and Affiliated to

Pt. B.D. Sharma University)

Original Certificates to be submitted along with 2sets of Photocopies:

1. Allotment letter from EAMCET /ICET/PGECET/ECET/GATE / other convener

2. Rank card of EAMCET/ICET/PGECET/ECET/GATE /other competitive examination (if any)

3. Photographs 8 No’s Passport Size Color

4. Class 10th Mark Memo

5. Class 12th Class/Graduation/ Diploma / other qualifying Mark Sheet.

6. Provisional Certificate / Original Degree Certificate

7. Conduct & Study certificate

8. School / College leaving certificate(TC).

9. Justification of gap year / Affidavit

10. Visiting card and AADHAR Card of parents and Student.

11. E-mail ID (Student) …………………………………………………………………..

12. E-mail ID (Parent) …………………………………………………………………..