www.upseeuptu2015.in confirmations

3/12/2015 www.upseeuptu2015.in/Confirmations.aspx http://www.upseeuptu2015.in/Confirmations.aspx 1/1 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 10033804 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 02/07/1997 Candidate's Name FAROOKH ALI ANSARI Category UPBC Father's Name RIYASAT ALI SubCategory NOT APPLICABLE Nationality INDIAN Rural Weightage NA Parent's Domicile U.P. Year of Passing 2014 Gender Male Qualifying Exam INTERMEDIATE Seeking Admission For B.Tech. Qualifying Exam Passed From U.P. Subject in 10+2 CHEMISTRY | MATHEMATICS | PHYSICS Paper(s) to Appear Paper 1 Choice of Exam Centres Varanasi | Mirzapur | Allahabad 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: FAROOKH ALI ANSARI Address: VILLBHATAULIYA POSTTENDU ROBERTSGANJ SONEBHADRA (U.P.) State: U.P. PinCode: 231216 Email ID: [email protected] Mobile No. 7523831073 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, 01042015. Details of Fee Transaction. For Application ID 10033804 Transaction ID. Mode of Payment Amount: Transaction Date DU12411646 SBI iCollect 800.00 05/03/2015 Note : Please ensure that all the entries are filled up and transaction details of bank are available on the confirmation page, failing which your application is liable to be rejected.

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3/12/2015 www.upseeuptu2015.in/Confirmations.aspx

http://www.upseeuptu2015.in/Confirmations.aspx 1/1

CONFIRMATIONPAGE:UPSEE2015(APPLICATIONFORMFORADMISSIONTOFIRSTYEARINB.TECH/B.PHARM./B.ARCH/BHMCT/BFAD/BFA/MAM/MBA/M.C.A.LATERALENTRY(SECONDYEAR)INB.TECH.ANDB.PHARMA)

RegistrationNo./ApplicationID10033804

YouhavesuccessfullysubmittedApplicationOnline.Kindlytaketheprintoutofthispage.Pasteyouronepassportsizephotographandputyoursignatureandthumbimpressioninthespecifiedbox.ModeofapplicationFormFilling Online DateofBirth 02/07/1997

Candidate'sName FAROOKHALIANSARI Category UPBC

Father'sName RIYASATALI SubCategory NOTAPPLICABLE

Nationality INDIAN RuralWeightage NA

Parent'sDomicile U.P. YearofPassing 2014

Gender Male QualifyingExam INTERMEDIATE

SeekingAdmissionFor B.Tech. QualifyingExamPassedFrom U.P.

Subjectin10+2 CHEMISTRY|MATHEMATICS|PHYSICS

Paper(s)toAppear Paper1

ChoiceofExamCentres Varanasi|Mirzapur|AllahabadDECLARATION

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: FAROOKHALIANSARI

Address:

VILLBHATAULIYAPOSTTENDUROBERTSGANJSONEBHADRA(U.P.)

State: U.P.PinCode: 231216EmailID: [email protected]. 7523831073

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,01042015.

DetailsofFeeTransaction.For

ApplicationID10033804TransactionID. ModeofPayment Amount: TransactionDateDU12411646 SBIiCollect 800.00 05/03/2015

Note:Pleaseensurethatalltheentriesarefilledupandtransactiondetailsofbankareavailableontheconfirmationpage,failingwhichyourapplicationisliabletoberejected.