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APPLICATION FORM NO:PEC UNIVERSITY OF TECHNOLOGY, CHANDIGARH

APPLICATION FORM $ FOR ADMISSION TO ME DEGREE COURSE(For filling this application form see instructions overleaf)

1. Full Name :

2. Date of Birth : 3. Place of Birth: 4. Sex: Male/Female

5. Marital Status: 6. Nationality:

7. Fathers Name :

8. Address for Correspondence:

State: Pin Code :

9. If available, please provide:

Phone No. : Fax No. :

E-mail address:

10. Details of Demand Draft(for photocopied/ website downloaded form)

a) Amount Rs . No. .. dt. ..

b) Bank & Branch issued ....

16. Academic Record/Work Experience

A. GATE exam details (*)Exam Name Exam discipline Score Exam Year

B. Qualifying Degree (*) already obtained or in progress University/Institute Discipline Degree Exam Date Final results

expected byMin. Pass Marks %

or Grade Average

% Marks or Sem. I Sem. II Sem. III Sem. IVGrade Point Average Overall % or

Grade AverageSem. V Sem. VI Sem. VII Sem. VIII (if degree completed)

C. Other Degrees (*) obtained after 10+2 (Do not include the degree listed in 16 B)University/Institute Discipline Degree Marks Date of completion

D. Working Experience (**)Dates (from-to) Name & Address of

Employer

Position Nature of Work

($) Copies downloaded from the PEC University of Technology website (http://www.pec.ac.in) are acceptable. The downloadedapplication forms are to be accompanied by a fee of Rs.1000/- (Rs.500/- for SC/ST/Physically handicapped candidates) in the form of adraft. In case a student is applying to more than one programme, photocopied forms can be used. In that case each additional form

must be accompanied by a fee of Rs.100/-. All forms submitted by the candidate must be received under the same cover. The total feemay be paid through a single draft. In favour of Director PEC University of Technology, Chandigarh(*) Attach attested copies of certificates, mark sheets etc. See checklist overleaf for certificates required.(**) A candidate presently working (including those on projects) must provide a No Objection/Relieving C ertificate from the employer. () In case the result is given in grade points an authenticated copy of formula for conversion to % marks should be attached.

To be filled in by the officeDiary No. Date: Signature:

Paste yourPhotograph

Here

Codes for Items 11-15 are given overleaf

11. Programme

12. Category

13. Student Status

14. Sponsorship Status

15. Physically Handicapped

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17. Declaration by the applicant:

(a) I hereby certify that the entries made by me in this form are correct to the best of my knowledge & I have notsuppressed any information in any manner.

(b) I agree to observe & abide by all the rules & regulations of the institute & the hostel that may be laid down from time totime by the PEC University of Technology, Chandigarh during the period of my studies & training & not to associatemyself with any activity prejudicial to the discipline of the institution.

(c) I fully understand that for any violation or infringement of these rules & regulations, disciplinary action can be takenagainst me by the authorities.

(d) I hereby solemnly affirm & declare that I have never been disqualified by any Board/University or convicted on anyaccount.

(e) I understand that if at any stage it is found that I have provided any wrong information or have suppressed anyinformation to seek admission to this institute, my admission shall automatically stand cancelled and I will have noclaim on the seat or the dues paid to the institute.

Date: ________ Signature: __________________________

I NSTRUCTIONS FOR F ILLING THIS F OR M

1. Either TYPE or PRINT the entries on the form neatly.2. Go through the codes for Items 11-15 given below, and fill them carefully in the boxes on Page 1.3. All items marked with an asterisk (*) require you to submit an attested copy of a supporting document. PLEASE DO NOT SEND

ORIGINALS. Documents for which attested copies are required are given in the checklist. Please tick off the items in thechecklist you are attaching to this form.

CODES (FOR ITEMS 11-15)

Item 11: Programme Codes: {Highways Engg.=HIG}, {Irrigation & Hydraulics Engg.=IRR},{Structural Engg.=STR},{Environmental Engg.=ENV},{Electrical Engg. = ELE},{Mechanical Engg. = MEC}, {Electronics=ECT}, {Industrial Materials & Metallurgical Engg. = IMM}, {Production &Industrial Engg. = PRO}, {Computer Science & Engg.. = CSE}, {Computer Science & Engg.(Information Security). = CSE(IS) }, {Total QualityEngineering & Management (TQE)}, { Industrial Design(IDE)}

Item 12: CategorySC* : Scheduled Caste (certificate required); ST* : Scheduled Tribe (certificate required); GN : General;

Item 13: Student Status : Full Time : FT; Part-Time : PTItem 14: Sponsorship Status : Sponsored (*) : SD; Non-Sponsored: NSItem 15: Physically Handicapped : PH (Physically handicapped certificate Clearly mentioning % of disability)

Format of Sponsorship Certificate (form I) is attached.

CHECKLIST (C IRCLE THE ENCLOSED DOCUMENTS ). SEND ONLY ATTESTED COPIES (NOT ORIGINALS ).

1. Date of birth (DOB) certificate or High School (Class Ten) Certificate with DOB (Required for all candidates)2. SC/ST Certificate if applicable (Item 12)3. Certificate of Physical Handicap (Type of disability to be attached).4. Sponsorship Certificate for sponsored candidates (Item 14) Form I5. GATE score card (Item 16 A)6. Copies of mark/grade sheets (Items 16 B & 16C)7. No Objection/Relieving Certificate from employer (for employed candidates)

8.

Migration Certificate from the institute attended last9. Undertaking from the institution attended for the non-declaration of result of the last semester / having appeared in last semesteras per format given in this application form.

10. The Demand Draft for application fees

The completed Application Form must reachThe Officer-in-Charge PG AdmissionsPEC University of TechnologyChandigarh-160012(Name of Parent Department should be superscribed on the envelope)

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Annexure-B

CERTIFICATE FOR APPEARING IN THE FINAL SEMESTER/YEAR EXAMINATION(Required from candidates who are yet to appear in the qualifying examination)

I hereby certify in connection with the application of Mr./Ms. ___________________________________

that he/she is a bonafide student of our institution and is applying for admission to PG programme(s) at

PEC University of Technology, Chandigarh. He / She is yet to complete the requirements of qualifying

examination including theory, practical and project examination for B.E./B.Tech./M.Sc./MCA

_____________________ (Strike out the non-applicable ones and write in the blank space if the degree is

not mentioned) and the result is likely to be announced by ______________ 2011. The percentage of

aggregate marks/CGPA obtained by him/her upto pre-final semester / year examination (Strike out the non-

applicable) is __________________. His/her conduct and character during his/her stay at the Institute /

University is GOOD.

Place: _________________ Signature of the Principal/Dean/Registrar/ Date: _________________ Dy. Registrar/Proctor/Administrative Officer/

Asstt. Registrar of the institute attending/lastattended with seal

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Annexure-C

CERTIFICATE FOR NON-DECLARATION OF RESULT(Required during registration from candidates whose result of the qualifying examination has not

been declared)

I hereby certify that Mr./Ms. _________________________________________ has appeared in the finalyear examination including theory, practical and project examination for

B.E./B.Tech./M.Sc./MCA________________ degree (strike out the non-applicable ones and write in the

blank space if the degree is not mentioned) and the result is likely to be announced by _______________

2011. The percentage of aggregate marks/CGPA obtained by him/her in the pre-final year/semester

examination is __________________ . His/her conduct and character during his/her stay at the

Institute/University/College was GOOD.

Place: _____________ Signature of the Principal/Dean/Registrar/ Date: _____________ Dy. Registrar/Proctor/Administrative Officer/

Asstt. Registrar of the institute last attendedwith seal

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SCRUTINY FORM FOR ADMISSION TO M.E. COURSES 2011 2012(A separate copy of scrutiny form is to be filled for each application submitted by the candidate)

Diary / Application No._______________(to be filled by the office)

PART A (to be filled by the candidate and to be checked by the scrutiny officers)

1. Name___________________________________________________________________________________

2. M.E. Programme applied for;

(a) ____________________________________________________

(b) ____________________________________________________

(c) ____________________________________________________

(d) ____________________________________________________

3. Category: _________________________________Gen (GN) /SC / ST / Sponsored (SD) / Handicapped (PH)/PT

4. Name of the qualifying examination passed (BE / B.Tech/MCA/AMIE / IETE etc.), branch of engineering/science, andthe university_________________________________________________________________________________

5. Marks secured

B.E./ B. Tech./MCA AMIE / IETE GraduatesSecured marks/Max. marks Section Secured / Max. marks

______________/___________marks Section A

Section B

Aggregate of Sections A and B:

Percentage:

6. Whether qualified in GATE? If yes, % score & Year_______________________________

CERTIFICATES ATTACHED WITH THE APPLICATION FORM(No separate certificates are to be attached with the scrutiny form)

1 Date of birth (DOB) certificate or High School (Class Ten) Certificate with DOB2 SC/ST Certificate3 Certificate of Physical Status (Type of disability to be attached)4 Sponsorship certificate for sponsored candidates5 GATE score card6 Copies of mark/grade sheets7 No Objection/relieving Certificate from employer (for employed candidates)8 Migration certificate from the institute attended last9 Undertaking from the institution attended for the non-declaration of result of the last semester / having appeared in last semester as per

format given in this application form.

Note: Circle the enclosed documents.

.

Signature of the candidate

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PART - B (To be filled by the Scrutiny Officers)

7. Is the degree from an AICTE approved college/ university or recognized by UGC. YES / NO

8. GATE qualified: YES / NO

9. GATE Score:B.E./B.Tech./MCA Score:

For AMIE / IETE candidates: (i) Whether passed Diploma before AMIE / IETE: YES / NO

(ii) Whether possesses 5 years experience: YES / NO

10. For Sponsored/Part-time candidates: Whether possesses requisite 2 years experience in the sponsoring organization: YES / NO

11. If physically handicapped, whether medical certificate attached YES / NO

12. Whether ELIGIBLE / INELIGIBLE:

13. Reasons if ineligible:__________________________________________________________

14. Deficient Documents, if any: _______________________________________________________________________________________________________

15. Any other remark: _______________________________________________________________________________________________________________________

______________ ________________

Scrutiny officer (I) Scrutiny officer (II)

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PEC UNIVERSITY OF TECHNOLOGY, CHANDIGARH

No. PEC/Stds-5/P.G. Admn./___________ Dated:

1. Your application for admission to the M.E. Degree Programme at this institute has been received

and entered at Sr. No.____________________ in the Register.

2. For all further correspondence with this office, you should quote the Sr. No. mentioned above with

the following particulars.

i. Branch / Specializationii. Category against which applied for

For Officer-in-Charge PG Admissions,PEC University of Technology,Chandigarh.

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[Write Your Address here legibly]

To____________________________________________________

_____________________________________________________

_____________________________________________________

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