Punjab Institute of Technology, GTB Garh (Moga)
(A Constituent College of Maharaja Ranjit Singh Punjab Technical University, Bathinda-151001)
Moga - Kotkapura Road, GTB Garh, Moga – 142049 (Pb.) Ph.: +91-1636-280806; Email – [email protected]
1. Admission 2020-21 (To be filled by the Candidate)
Fee Slip No. ______________________ Date of Admission ______________
Registration No.______________________ LEET Rank____________________
Name of Candidate____________________ Date of Birth ____________________
Father’s Name: _______________________ Father’s Occupation_____________ PHOTO Mother’s Name: ______________________ Mother’s Occupation: ____________
Branch Allotted _______________________ Under 85% or 15%______Category:________Sub Cat._____
Gender_________________________ Mode of Admission (Fee waiver/CM Scholarship/PMSS/Gen)______________
2. DECLARATION BY CANDIDATE
I________________________________ S-D/o (Sh. &Smt.) _____________________________________do hereby solemnly affirm and declare as under:
1. That I will not indulge in any kind of ragging or indiscipline during my entire stay in Punjab Institute of Technology GTB Garh (Moga). I will abide by the rules and regulations of this college and Maharaja Ranjit Singh Punjab Technical University, Bathinda. I am aware that authorities may take any suitable action against me including expulsion from college in case of any violation.
2. That I discontinued my studies from __________ to _______. During this period I was not involved in any offence or illegal activity and no criminal case is pending against me in any court.
3. That I will submit all of my original certificates as & when demanded by the college/University.
4. That all the documents furnished by me are correct and true to the best of my knowledge and belief and nothing has been concealed therein. I understand that I will be fully liable for legal proceedings against me if the information supplied by me is found wrong at any stage in future and my admission will automatically be cancelled from College rolls.
Signature of Candidate: ___________________ Counter Signature of Parents/Guardian: ____________________________
E-mail Address: ______________________________________________________ Blood Group________________________
Candidate Mobile No. _____________________________________________________________________________________
3. DECLARATION BY PARENTS/GUARDIAN
I _________________________Parent/Guardian of Ms./Mr._______________________________________________________
Address: ________________________________________________________________________________________________
Parents Mobile No’s:__________________________________________________________do hereby solemnly affirm and declare as under: a)That I and my ward are citizens of India.
b) That neither the deponent nor the child/ward of the deponent has obtained the benefit of Residence in any other state.
Dated ___________________ DEPONENT
Verification:
Verified that the contents of my declaration above are correct and true to the best of my knowledge and belief and nothing has been concealed therein.
Dated ___________________ DEPONENT
PHOTO
Punjab Institute of Technology, GTB Garh (Moga)
(A Constituent College of Maharaja Ranjit Singh Punjab Technical University, Bathinda-151001)
Moga - Kotkapura Road, GTB Garh, Moga – 142049 (Pb.) Ph.: +91-1636-280806; Email – [email protected]
(FOR OFFICE USE ONLY) Certificate Verification:
1 Allotment
Letter(IKGPTU/MRSPTU/DIRECT) 8
Calculation of % of Marks
(1st Year 25%, 2nd Year 50% & 3rd Year 100%),(10+2)
2 Counselling fee Deposit Slip 9 Character Certificate (Latest)
3 Category Certificate(if applicable) 10 Medical Fitness Certificate (with Photo)
4 Residence Certificate 11 Income Certificate (In case of Fee Waiver)
5 Matriculation Certificate 12 Migration Certificate
6 DMC of Qualifying Exam (10TH/Diploma/10+2)
13 Gap Certificate (if applicable)
7 AADHAR card Copy (parents and candidate) 14. JEE ADMIT CARD AND RESULT CARD
Dealing Official: 1(Name&Sign.) …... Dealing Official: 2(Name&Sign.)...
_________________________________________________________________________________________
(Admission Committee)
Allowed to deposit Fee (Provisional-in case of deficiency, if any)
(Member-1) (Member-2) (Member-3) Chairman
Signature Signature Signature Signature
__________________________________________________________________________________
Fee Deposited: Yes No Total Amount Deposited:
₹._____________________Cash/Draft _________________________________
_________________________________________________________________ (Supdt. Accounts) __________________________________________________________________________________
Seat Confirmation i. Institute Allotted: Punjab Institute of Technology GTB Garh (Moga)
ii. Branch Allotted: ______________under 85%/15%__________Category______________________
According to PTU web-portal, the above said branch has been allotted to the students with/without any deficiency.
The print out of the same is attached herewith for the signature of Admission Committee)
1._________________________ 2._______________________ (Signature of Online Admission Committee) i. Student admitted with/without deficiency
ii. Admission kept pending up to ________________________________________________________
iii. Student not admitted because of ______________________________________________________
_____________________________________________________________ (Signature of Admission Committee)
