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   Collge Code : 282
 
       

 

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  Registration Form

 
Academic Session * :
     
Course * : Branch * :
Candidate Name * :
Email Address* :
Date of Birth * : ( Formate: DD/MM/YYYY)
Place of Birth :
Nationality * :
Religion :
Sex : Male Female
Caste :
Academic Qualification :
Exam Passed Board/ University Year of Passing Subject %of Mark obtained
High School
Intermediate/10+2
Graduation
Any Other
Percent Marks in PCM(Intermediate/10+2)*
Roll. No. UPSEE/AIEEE UPSEE/AIEEE Rank
Mention Hobbies / Interests / Games and Sports / Prizes won.


Hostel accommodation required :     Yes No
Name of Father * :
Occupation of Father :
Name of Mother * :
Occupation of Mother :
Annual Income Rs :
Telephone No. (Resi.) * :
How Do You Know About The Institute:    
Facebook
News Paper
Friends
Others
Full Postal Address of Parent with Telephone No. (Residence) *

Permanent Home Address

Upload Photograph :

DECLARATION

We declare that the information furnished above is true to the best of our knowledge and belief. If any information furnished is found incorrect, the admission may be cancelled forthwith. We undertake to comply with the rules and regulation of the Institute. Which have been read by us in the information brochure and understood and shall make payment of the fees and dues of the Institute as scheduled and in time. The Institute shall have full right to cancel the admission in case any document submitted by us is found to be false or forged at any stage during the course of study. We also understand that all legal matters shall fall under the jurisdiction of courts of law at Meerut.

   I am Agree

 

    

 
 
 
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Mawana Road, P.O. Rajpura, Meerut
     info@jpiet.com
     Ph: +91 (121) 2623009, 2622499
     Fax: +91-121-2623007