Application For :

B.Tech.

B.Arch.

M.B.A.

BS/B.B.A.

MS/M.B.A.

Branch (As the case may be)

Details of the Student :

First Name (In English) *

Middle Name(In English)

Surname (In English)

First Name (In Hindi)*

Middle Name (In Hindi)

Surname (In Hindi)

Date of Birth (DD/MM/YYYY) *

Gender*

Male Female

Blood Group

Religion *

Caste *

SC ST OBC GEN Minority

Permanent Address Details :

Address *

District*

State*

PIN*

Phone No.*

Mobile No.*

Present Address Details :

Address*

District*

State*

PIN*

Phone No.

Mobile No.*

Admission Details :

Hostel Required *

YES NO

Bus Required *

YES NO

Admission Mode (UPSEE/AIEEE/NATA/MAT/CAT) Any Other, Please Specify

Roll No

Year Appeared

Rank/Score

Select Your Preference*

Fee Waiver Paid Seat

Educational Details :

S.No.	Board/University Name	Subject / Course	Year	Roll No	Max Marks	Marks Obtained	Grade / Percentage
1	10th
2	12th
3	Diploma(please specify)
4	B.Tech./B.C.A./B.Com. /B.A./B.Sc./B.B.A./Other

For B.Tech. & B.Arch. (not required for M.B.A.)

Physics		Maths		Chemistry		Aggregate	Percentage(%)
Max.	Obtained	Max.	Obtained	Max.	Obtained

Parent's Detail :

Father's Profession and Address

Name *

Address & Phone No. *

Profession *

Organisation Address & Ph.No. *

Annual Income in Rs.

Mobile No. *

Mother's Profession and Address

Name *

Address & Phone No. *

Profession *

Organisation Address & Ph.No.

Annual Income in Rs.

Mobile No. *

Other Information :

Income Cerificate No. & Date

Caste Certificate No. & Date

Domicile(U.P. or Other State) & Number

Sub Category (Please Select)

Physically Handicapped

Freedom Fighter

Ex-Defence Personnel

Foreign Nationals

NRI

None

Family Financial Status

Annual Income in Rs. *

LIG

NON-LIG

Upload Files :

Photo *
(only .jpg allowed)

Sign *
(only .jpg allowed)

Declaration :

I hereby declare that the information given in the application form is true to best of my knowledge and belief. If any information is found to be wrong, I shall be liable for action. I hold myself responsible for the due and prompt payment of fees.

Ansal Technical Campus(Code-748)

Ansal School of Architecture(Code UP-30)

Application Form

For B.Tech. & B.Arch. (not required for M.B.A.)

Father's Profession and Address

Mother's Profession and Address

Sub Category (Please Select)

Family Financial Status