Great Ganges Institute of Technology GGE Complex, Kanpur-Lucknow Highway

Fill this form in CAPITAL LETTERS.Programme applied for (Tick on the relevant box) BBA BCA

1. Applicant’s Personal Details Name …………………………………………………………………………………………………………………………………………………..

(First Name) (Middle Name) (Sur Name)

Date of Birth Blood Group ………………………...…………..

Father’s Name ………………………………………………………………………………………………………………………………………

(First Name) (Middle Name) (Sur Name)

Mother’s Name ……………………………………………………………………………………………………………………………………. (First Name) (Middle Name) (Sur Name)

Category (General/OBC/SC/ST) and Caste ………………………………........................................................

Annual Family Income………………………………………………………………………………………………………………………….

2. Address for correspondence Permanent Address

………..…………………………………………………………….. ………………………………………………………………………

……………………………………………………………………….. ……………………………………………………………………….

………………………………………………………………………. ……………………………………………………………………….

PIN ……………………………………………………………….. PIN …………………………………………………………………

Mb: ………………………………………………………………. Mb: ……………………………………………………………….

E-mail ……………………………………………………………. E-mail …………………………………………………………….

3. Academic Record

Exam

Passed

School/ College Board Year of

Passing

Subjects %age

Marks

10th

12th

Other

ADMISSION

Affix a recentPassport-sizePhotograph

D D M M Y Y Y Y

4. Fee Demand Draft Details:

Bank Name & Branch……………………………………………………………………………………….Issue Date…………………………….

Draft Number………………………………………………………….Amount…………………………………………………………………………

Date:…………………………….. Applicant’s Signature

Please attach photocopies of the follows:

1. High School Mark Sheet & Certificate

2. Intermediate Mark Sheet

3. Transfer Certificate (TC)

4. Character Certificate

5. Gap Affidavit (if any)

6. 6 Passport Size Photo

7. Caste Certificate (In the case of SC/ST/OBC)

8. Income Certificate

9. Domicile Certificate

Attach a demand draft for the fee in favor of the ‘GREAT GANGES INSTITUTE OF TECHNOLOGY’ payable at

KANPUR. Write the applicant’s name, address, and the course name applied for on the back of the demand

draft.

Provisional admission will be granted to candidate who has appeared in the class 12th examination of a

recognized Board and the same shall be confirmed on production of the proof of having passed the aforesaid

examination at least a week before the last date of submission of the examination/enrollment form of the

affiliating University.

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FOR OFFICE USE ONLY

Admitted Waiting

Rejected On Hold (Head of Admissions)

Date …………………..