Uptu
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CONFIRMATION PAGE : UPSEE2015 (APPLICATION FORM FOR ADMISSION TO FIRST YEAR IN B.TECH / B.PHARM. / B.ARCH / BHMCT / BFAD/ BFA/ MAM / MBA / M.C.A. LATERAL ENTRY (SECOND YEAR) IN B.TECH. AND B.PHARMA) Registration No. / Application ID 30285982 You have successfully submitted Application Online. Kindly take the printout of this page. Paste your one passport size photograph and put your signature and thumb impression in the specified box. Mode of application Form Filling Online Date of Birth 11/02/1993 Candidate's Name SANDEEP RAO Category UPSC Father's Name RAMCHANDRA RAO SubCategory NOT APPLICABLE Nationality INDIAN Rural Weightage NA Parent's Domicile U.P. Year of Passing 2014 Gender Male Qualifying Exam GRADUATION Seeking Admission For MBA Qualifying Exam Passed From U.P. Subject in 10+2 Paper(s) to Appear Paper 9 Choice of Exam Centres Lucknow | Bahraich | Faizabad DECLARATION I certify that the particulars given by me in this Application Form are correct to the best of my knowledge and belief and any mastake / misinformation detected at the time of counselling or at any stage will result in the cancellation of admission I have carefully read the Information Brochure of UPSEE 2015 and agree to abide by the terms and conditions laid down there in. Further, it is entirely my responsibility to prove the eligibility for admission to the 1st year of B.Tech. / B.Arch. / B.Tech.(Agriculture Engg.)/ B.Tecch.(Bio Tech) / B.Pharma./ B.HMCT / BFAD / BFA / 2nd year of B.Tech./ B.Pharma course(s) in respect of qualification and entitlement for admission against reserved category, if claimed, to the satisfaction of the UPSEE2015. Further, I undertake that I will be visiting the website (http://upseeuptu2015.in) regularly for any information and I declare that all the information regarding UPSEE2015 provided on these website will be treated as served. Name: SANDEEP RAO Address: Sufipura,near forest office, Bahraich State: U.P. PinCode: 271801 Email ID: [email protected] Mobile No. 9044325116 Uploaded Signature Uploaded Thumb Impression Place your recent coloured photograph as printed on confirmation form (3.5cm x 4.5cm) Left Hand Thumb Impression Signature of the Candidate(Not in capital letters) Signature of Parent/Guardian Send this form along with copy of Bank Challan(if fee paid by Bank Challan) to "REGISTRAR, UPSEE2015, UTTAR PRADESH TECHNICAL UNIVERSITY, I.E.T.CAMPUS, SITAPUR ROAD, LUCKNOW226021,(U.P.)" so as to reach latest by 5PM, 09042015.
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3/27/2015 https://upseeuptu2015.in/Confirmations.aspx
https://upseeuptu2015.in/Confirmations.aspx 1/2
CONFIRMATIONPAGE:UPSEE2015(APPLICATIONFORMFORADMISSIONTOFIRSTYEARINB.TECH/B.PHARM./B.ARCH/BHMCT/BFAD/BFA/MAM/MBA/M.C.A.LATERALENTRY(SECONDYEAR)INB.TECH.ANDB.PHARMA)
RegistrationNo./ApplicationID30285982
YouhavesuccessfullysubmittedApplicationOnline.Kindlytaketheprintoutofthispage.Pasteyouronepassportsizephotographandputyoursignatureandthumbimpressioninthespecifiedbox.ModeofapplicationFormFilling Online DateofBirth 11/02/1993
Candidate'sName SANDEEPRAO Category UPSC
Father'sName RAMCHANDRARAO SubCategory NOTAPPLICABLE
Nationality INDIAN RuralWeightage NA
Parent'sDomicile U.P. YearofPassing 2014
Gender Male QualifyingExam GRADUATION
SeekingAdmissionFor MBA QualifyingExamPassedFrom U.P.
Subjectin10+2
Paper(s)toAppear Paper9
ChoiceofExamCentres Lucknow|Bahraich|FaizabadDECLARATION
IcertifythattheparticularsgivenbymeinthisApplicationFormarecorrecttothebestofmyknowledgeandbeliefandanymastake/misinformationdetectedatthetimeofcounsellingoratanystagewillresultinthecancellationofadmissionIhavecarefullyreadtheInformationBrochureofUPSEE2015andagreetoabidebythetermsandconditionslaiddowntherein.Further,itisentirelymyresponsibilitytoprovetheeligibilityforadmissiontothe1styearofB.Tech./B.Arch./B.Tech.(AgricultureEngg.)/B.Tecch.(BioTech)/B.Pharma./B.HMCT/BFAD/BFA/2ndyearofB.Tech./B.Pharmacourse(s)inrespectofqualificationandentitlementforadmissionagainstreservedcategory,ifclaimed,tothesatisfactionoftheUPSEE2015.Further,IundertakethatIwillbevisitingthewebsite(http://upseeuptu2015.in)regularlyforanyinformationandIdeclarethatalltheinformationregardingUPSEE2015providedonthesewebsitewillbetreatedasserved.
Name: SANDEEPRAO
Address: Sufipura,nearforestoffice,BahraichState: U.P.
PinCode: 271801EmailID: [email protected]. 9044325116
UploadedSignature
UploadedThumbImpression
Placeyourrecentcolouredphotographasprintedonconfirmationform(3.5cmx4.5cm)
LeftHandThumbImpression SignatureoftheCandidate(Notincapitalletters) SignatureofParent/Guardian
SendthisformalongwithcopyofBankChallan(iffeepaidbyBankChallan)to"REGISTRAR,UPSEE2015,UTTARPRADESHTECHNICALUNIVERSITY,I.E.T.CAMPUS,SITAPURROAD,LUCKNOW226021,(U.P.)"soastoreachlatestby5PM,09042015.
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3/27/2015 https://upseeuptu2015.in/Confirmations.aspx
https://upseeuptu2015.in/Confirmations.aspx 2/2
DetailsofFeeTransaction.For
ApplicationID30285982TransactionID. ModeofPayment Amount: TransactionDateDU14151595 SBIiCollect 400.00 25/03/2015
Note:Pleaseensurethatalltheentriesarefilledupandtransactiondetailsofbankareavailableontheconfirmationpage,failingwhichyourapplicationisliabletoberejected.
