APPLICATION NO.

13105962

INDIAN INSTITUTE OF TECHNOLOGY ROORKEE

APPLICATION FOR ADMISSION TO
M.TECH./M.ARCH./M.U.R.P. PROGRAMMES-2013
A Passport Size Photograph should be pasted in this space

GATE REGISTRATION NO:

EE11582239

1. Name of the Candidate : RAMA RAVI TEJA 2. Fathers Name: RAMA SATHYANARAYANA 4. Date of Birth: 14-October-1991 6. Nationality: Indian 7. Category : OBC 9. Qualifying Exam Passed:
Yes No

3. Mothers Name: FATHIMA MARY 5. Gender :

Male

8. Person with Different Ability: Qualifying Degree : Likly to Clear:

B.E.

No

Any back paper(s)/ Supplementary(ies): Subject Name:

(A candidate will be required to complete and have passed/appeared the qualifying examination including back paper(s) /supplementary(ies) examination by the date of registratrion i.e. July 17, 2013)

10. Percentage of Marks/CGPA: 76.000 11. Bachelors Degree from an IIT: 12. GATE Qualified:
Yes No

CGPA-Point Scale/Max. Marks 100.000 If yes, Name of the IIT: 13. GATE Discipline (Code): EE 15. GATE Qualifying Year: 2013

14. GATE Marks Out of 100: 42.33 16. Whether Sponsored Candidate:
(for candidates already in employement)

No

If Yes, Admission required :

17. Maths at 10+2 Level:

No

Maths at Graduation Level:

Yes

18. Departments/Centres Applied 1

EED

19. Codes of Academic Programme, Preference wise (As per Table-2 of Information Brochure-13) Choices once given shall not be changed for any reason after submission of online application.
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27

29

30

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20. Amount of Application Fee including Fee for Additional Deptts. Paid (Rs.400-700): Rs. 440.00 22. Complete Postal Address for Correspondence 10-5-779/37/A,VENKATNAGAR THUKARAMGATE,NORTH LALAGUDA SECUNDERABAD ANDHRA PADESH Pin Code: 500017 Email: ramaa.raviteja@gmail.com Mobile No. 8121815201 Telephone No. 040 Fax No.

23. DECLARATION BY CANDIDATE I hereby declare that all the particular stated by me in this application form are true to the best of my knowledge and belief. I have read the Information Brochure of PG Admission -2013, IIT Roorkee given on Institute Website and I shall abide by the terms and conditions given therein. It is entirely my responsibility, to prove my eligibility for admission to the Programme(s) for which I am admitted and also, in respect of qualifications and entitlement for admission against reserved category, if claimed, to the satisfaction of the Institute. Further, in the event of suppression or distortion of any fact like category, educational qualifications, nationality, etc., made in my application form, I understand that my admission, if granted or degree /diploma acquired subsequently, is liable for cancellation. I also understand that the decision of IIT Roorkee regarding my admission, will be final and I shall abide by the ordinances and regulations of IIT Roorkee, in vogue form time to time. I have read Section 8.9 of the Information Brochure regarding the institutions approach toward ragging and the punishments to which I am liable if found guilty of ragging. Further, if admitted, I promise to abide by the statutes, ordinances and regulations of IIT Roorkee. I further declare that I have not taken admission and registered for any Postgraduate programme at the Institute at the level for which I am applying. I also clearly understand that I have to complete and pass the qualifying examination including back paper (s)/supplementary(ies), if any by the scheduled date of registration to the programme i.e. July 17, 2013. In the event I am granted admission /registered to the programme and later on it is found that I have appeared in the examination or for a back paper/supplementary(ies) for any subject and passed it after the date of scheduled registration to the programme my admission /registration shall stand terminated and I will not be entitled to any claim from the IIT Roorkee.

24. Full Signature of candidate

Place............................... Date Enclosures: 1. Xerox / Downloaded copy of GATE score card 2. Copy of Final year marks sheet/Pre final year marks sheet 3. Proof of Mathematics at 10+2 or higher level marks sheet (If applicable) 4. Copy of Persons with Disability (PD) certificate (If applicable) 5. SC/ST candidates should attached caste certificates from the competent authorities. Candidates belonging to OBC category must submit Xeroxed copy of category certificate on GOI format.Certificate should have been issued after 31.03.2012 by a competent authority. 6. Annexure 1 / 2 / 3 / 4 / 5 as applicable.

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