B.

Tech/SOE/Application Form
Application No: PU/B.TECH/23/127693

Programs And Courses

FULL TIME 4-YEAR B.TECH B.TECH. - COMPUTER SCIENCE AND
Admission Intake 2023-24 Program Course Preference
DEGREE ENGINEERING

Personal Details
Name MR SHIVANG VERMA
Mobile No. +91-6386684856
Email Id SHYAMLAL86029@GMAIL.COM
Gender MALE
Date Of Birth 12/09/2005
Place Of Birth LUCKNOW
Blood Group A+
Marital Status SINGLE
Religion HINDUISM
Person With Disabilites(PWD) NO
Do You Required Transport
Do You Required Hostel Facility NO
Residence Status INDIAN
Please Select As Applicable NON KARNATAKA
Caste Category OBC
Aadhar Card Number 684584367645
Nationality
VISA Type
VISA Number
Country Of Residence
Passport Number

Parent's Details:
Parent Details : SHYAM LAL
Parent'1 Details Parent'2 Details Guardian's Details:
Name SHYAM LAL SIMRITA KATIYAR
Mobile No. +91-9415911439 +91-7755001882
Email Address SHYAMLAL86029@GMAIL.COM SHYAMLAL86029@GMAIL.COM
Father's PAN Card No.
Occupation GOVERNMENT SECTOR HOMEMAKER
Designation MC WELDING SECTION
Family's Annual Income BELOW 1 LAKHS

Address Details:
Is Permanent Address Same as Communication Address: YES
Communication Address Permanent Address
Address B-41/3 R.D.S.O. COLONY MANAK NAGAR LUCKNOW B-41/3 R.D.S.O. COLONY MANAK NAGAR LUCKNOW
Town/City LUCKNOW LUCKNOW
District LUCKNOW LUCKNOW
State UTTAR PRADESH UTTAR PRADESH
Country Name INDIA INDIA
Pin Code 226011 226011

Educational Details
After 10th Qualification 12TH
X XII Diploma
Institution Name KENDRIYA VIDYALAYA R.D.S.O. KENDRIYA VIDYALAYA R.D.S.O.
CENTRAL BOARD OF SECONDARY
Board/University CENTRAL BOARD OF SECONDARY EDUCATION (CBSE)
EDUCATION (CBSE)
Stream - SCIENCE
Result Status - DECLARED
Register Number /Rollno 23223258 23706479
Marking Scheme PERCENTAGE - -
Percentage/CGPA 92.6 62.8
Year of passing 2021 2023

12th Subject Wise Details:

S.no Subject Maximum Marks Obtained Marks Obtained Percentage
1. MATHS 100 50 50
2. PHYSICS 100 67 50
3. CHEMISTRY 100 80 80
4. ENGLISH 100 72 72
5. COMPUTER SCIENCE 100 72 72
Total 500 341 68.2

Entrance Exam Details:

Have You Appeared For Any Entrance Exam : NO
Entrance Test Details
Year of
S.no Exam Exam Roll No Result Status Score All India Rank
Appearing
1.
2.

Others Details:
Achievements / Extracurricular / Sports:
Awarding
S.no Achievement at Name of Award Academic Level Basis of Award Year
Institution
1.
2.
3.
How Did You Came To Know About Presidency University
How Did You Came To Know About Presidency University FRIENDS / CLASSMATES / PARENTS

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Upload Your Recent Passport Size Photograph

Upload Your Signature

Upload Your 10th Certificate YES

Upload Your 12th Certificate YES
Upload Your Diploma Certificate NO

Declaration
I Hereby Declare That The Entries Made By Me In This Application Form Are True In All Respects And If Any Entry Or Information Is Found To
Be False, This Shall Entail Automatic Cancellation Of My Admission Besides Rendering Me Liable To Such Action As The University May Deem
Appropriate. I Undertake That I Have Read The Terms And Conditions Mentioned Above & I Will Abide By The Same. I Understand That My
Admission Will Remain Provisional Till All My Documents Are Verified & I Fulfill All The Eligibility Criteria Of The Statutory Bodies. I Note That
My Admission To The University And My Continuance On Its Rolls Are Subject To The Provisions Of The University And Any Other Rules And
Instructions, Which May Be Issued, From Time To Time. I Shall Abide By The Rules Of Discipline And Proper Conduct, Which May Be Framed In
This Regard. I Fully Understand The Regulations And Directions Banning Ragging And Affirm That I Shall Not Indulge And Involve Myself In
Any Act Of Ragging.
I Also Undertake To Submit An Affidavit At The Time Of Admission As Required By The University’s Student Policy. I Solemnly Affirm That I
Have Never Been Convicted By A Court Of Law Nor Rusticated/Expelled From Any Educational Institution Nor Disqualified/Debarred From Any
Examination.

Applicant Name: SHIVANG VERMA Parent Name : SHYAM LAL

Date: 12/09/2005