EAMCET Hall Ticket No. General Rank

( To be filled in English by the candidate )

1. (a) Name ( In block letters as per S.S.C Record )

(b) Father's Name ( In block letters as per S.S.C Record )

(d) Date of Birth (c) Gender Male Female

(e) Religion (f) Caste

(g) Nationality (h) Mother Tongue

(i) Place of Birth

Country State Village/Town

(j) Community status OC OC-EBC BC A B C D SC ST (k) Blood Group

(l) Supernumerary Status PH Ex-servicemen NCC NSS Sports

2. Address for Communication (a) Permanent

Pin

Phone Mobile Residence O ffice

(b) Local Pin

Student Email Father/Gaurdian Email

AFFIX YOURLATEST

PHOTOGRAPH

www.nri.edu.in

NRI INSTITUTE OF TECHNOLOGYApproved by AICTE, New Delhi & Affiliated to JNTU, Hyderabad

Campus: Kothur (V), Near Gudur Gate, Kandukur (M), Srisailam Highway, R.R.Dist, Greater Hyderabad-501 359.City Center: 3rd Floor, Soni Complex, Prashanthi Nagar, Y-Junction, Kukatpally, Hyderabad 500072

Ph: 91776 00031/38/35, 9989338483. e-mail: office@nri.edu.in

APPLICATION FORM

FORM No.: REGISTRATION No.:

Marks Subject

IMPORTANT NOTE: a) Incomplete application will not be considered.

b) The candidate or parent must be in touch with the administrative office of college to know the

result of selection and the last date for remittance of fee. The administrative office

takes no responsibility for communicating the information with regard to payment of

admission fee & submission of application form.

The Following Documents are to be submitted at the time of admission

Passport Size Photographs - 10

EAMCET Documents - 2 Sets

1. Rank Card

2. Hall Ticker

3. Allotment Order

4. Fee Challan

Education Related Documents - 2 Sets

1. SSC Certificate

2. Intermediate / Diploma Memorandum of Marks

3. Study & Conduct Certificare - SSC, Intermediate

4. Transfer Certificate

5. Gap Certificate ( Applicable for Students who passed last year or before)

Fees Reimbursement Related Documents - 2 sets

1. Caste Certificate issued by the Competent authority in case of BC/SC/ST Candidates

2. Income Certificate from MeeSeva

3.Aadhar Card

4. Ration / Voter ID Card

5. Bank Pass Book Front Page

Non-Local / Out of State Students - 2 Sets

1. Residence Certificate of Father / Mother for a period of 10 years in AP from MRO in case of non-local Candidates.

2. Migration Certificate

3. Equivalence Certificate from out of State Students (SSC&Inter)

NOTE:

1. The Application will not be considered, if the required Certificates are not enclosed.

2. Original Form to be submitted in College Office.

3. Duplicate Form to be Submitted in DEO-Hyderabad Office

ADMISSION INCHARGE PRINCIPAL

For Admission to B.Tech Course

1. PET (Petroleum Engineering)2. CSE (Computer Science Engineering)3. ECE (Electronics & Communication Engineering)4. CE (Civil Engineering)5. ME (Mechanical Engineering) 6. AUT (Automobile Engineering)

NRI

Management

Counselling

Spot

Lateral Entry

TYPE OF ALLOTMENT:

Academic Year: 201 - 201 Date of Admission: / /

4. (a) Father's Name / Guardian’s Name

Qualification

Occupation

Place of work

(b) Mother’s Name

Qualification

Occupation

Place of work

(c) Fill the following only if you married

Spouse's Name

Qualification

Occupation

Place of work

Number of children

5. Total Annual Income

6. Academic Information:

S.S.C / ICSE / CBSE

Intermediate/Diploma

B.Tech

Any Other

(Tick on Appropriate item)

3. Identification Marks 1) 2)

PLACE:

DATE: Signature of Parent / Guardian

DECLARATION BY THE APPLICANT

I declare that all particulars furnished above are correct. I know that, Admission in this is subject to the cond i t ions la id

down by Jawaharlal Nehru Technological University and NRI Educational Society. If any of my statements

are found incorrect on scrunity, my admission may be cancelled at any time during the course of study. I have

not suppressed any information. I shall abide by the decision of the Management of NRI Institute of Technology.

On admission, I shall never demand for any refund of fees due to discontinuance of the course for any reason(s).

PLACE:

DATE: Signature of the Applicant

DECLARATION BY THE PARENT / GUARDIAN

I Certify that particulars furnished by my son / daughter / ward are correct, if any of these

statements are found in-correct in scrutiny, admission may be cancelled at any time during the

course of study. I shall be solely responsible for his/her conduct, good behaviour and

compliance with the rules enforced from time to time during the entire period of his / her

study in the college. The decision of the management of the college is final. In all matters,

I shall be responsible for the payment of the tuition fee and other fees prescribed by the college

management. I shall never demand for any refund of fees at any time due to discontinuance of

the course for any reasons(s)

Exam Registration No.

Name of the Institution attended

Year of passing

Medium of Instruction

Marks

Awarded DivisionQualification State