Step iii : online application form –

K.J.Somaiya Institute Of Engineering & Information Technology
Sion, Mumbai. Pin – 400 022
(AICTE Approved – Affiliated to Unversity of Mumbai) Online Application Form for Admission to Academic Year 2013 – 2014 for Regular Students
Admitting Center : KJSIEIT, Sion, Mumbai
Space for Office Use
Application Verified

_____________________
In-charge of Exam Cell

Eligible for admission to Sem
Registration No.
Member ID

_____________________
Student’s Section

Fees Details :  
Receipt No. :  
Date :  

_____________________
Accounts Section

Admitted Provisionally / Finally to Sem-

_____________________
Registrar

_____________________
Principal

spacer spacer
APPLICATION NO.
REG. NO.
Member ID
Sem –
1. Particulars of the Applicant
a) Name :
b) Mother’s Name :  
c) Address for Correspondence :   City :  
d) Pincode :   e) Telephone No. :  
f) Mobile No. :   g) Email :  
h) Date of Birth :   i) Place of Birth :   j) Gender :   k) Religion :  
l) Category :   m) College Joining : Period : – 
n) Admission Quota :  
o) Physically Handicapped :   p) Rail concession facility :  
 
q) Availing Bank Loan :   r) Availing EBC Facility :
s) Stays At : t) Blood Group :
u) Aadhar No. :  
v) Amartya Insurance Details :
Name of the Student :
Age : Yrs.
Name of the Earning Parent / Legal Guardian :
Relationship with Student :
2. Particulars of the Parent / Guardian
a) Name :
b) Address for Correspondence :   City :  
c) Pincode :  
d) Telephone No. :   e) Mobile No. :  
f) Email :  
3. Previous Examination Details
Semester Course Month / Year Result (Pass / Fail) Percentage No. of live ATKTs
Sem I    –      
Sem II    –      
Sem III    –      
Sem IV    –      
Sem V    –      
Sem VI    –      
   
 
   
Date  :____________________ Place :____________________ _________________________________
  (Signature of Candidate)
Self Signed Copies of following documents required while submitting the application form:

Leave a Reply

Your email address will not be published. Required fields are marked *