VELAGAPUDI RAMAKRISHNA

SIDDHARTHA ENGINEERING COLLEGE

NAAC ―A+‖ Grade - Autonomous – Affiliated to JNTUK: Kakinada
Approved by AICTE – Estd. 1977 - AN ISO 9001 : 2015 Certified Institution

Sponsors: Siddhartha Academy of General & Technical Education, Vijayawada

Form No.

APPLICATION FORM FOR ADMISSION INTO FIRST YEAR B.TECH. COURSE 2021-2022
Category B – NRI / NRI Sponsored Seats (15%)
Branch Opted : 1) 2) 3) 4)
FOR OFFICE USE ONLY
Regn.No.
Admission No. Affix Passport size
Photograph
Date of Admission
Roll No.

1. Name in full (Capital letters)

(as per school records) :

2. Sex : Male Female

3. Date of Birth (as per school records) :

4. Age (in years) :

5. (a) Father’s Name & Occupation :

(Give details)

(b) Mother’s Name & Occupation :

(Give details)

(c) Annual Parental Income :

(In Rupees / US $)
6. (a) Nationality : (b) Mother Tongue :

7. Permanent Address of the applicant :

(complete postal address with PINCODE)
(Country of domicile)
District:
Land Phone No. with STD code Mobile No.

email ID
8. Address for communication during
the course of study :
(Complete Postal address with PINCODE)
(in India)

Land Phone No. with STD code Mobile No.

email ID

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9.a) Name, Occupation and address of Local Name :
Guardian if the applicant is from outside India :
(Complete Postal address with PINCODE) Relation :

Address :
Land Phone No. with STD code
Mobile No.:
email ID
b) Name, Occupation and address of the NRI Name :
Sponsorer (Complete Postal address
with PINCODE) Relation (if any):
(Proof of address and occupation to be
enclosed) Address :

Mobile No.:
Land Phone No. with STD code

email ID
10. Particulars of Qualifying Examination Passed

Name of the Institution where studied and : _______________________________________

country
Month & Year of Passing : _______________________________________

Main Subjects completed : _______________________________________

CGPA on a scale of 10 : _______________________________________

Passport No. / Issuing Country : _______________________________________

Visa Valid Upto : _______________________________________

Other than Intermediate

Whether Equivalency Certificate is enclosed : Yes / No.
(Issued by Association of Indian Universities and Board of Intermediate Education)

Subject Marks Maximum Subject Marks Maximum Marks

Obtained Marks Obtained
Languages Group

Marks obtained Maximum Marks

Total Marks obtained in all Subjects / Grades

Total Marks obtained in Group Subjects / Grades
Percentage obtained in Group Subjects :

Percentage obtained Overall :

Whether qualified in entrance test : Yes / No
Conducted by State Government or If yes,
JEE Mains / AIEEE Rank obtained

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11. Institutions attended previously (from Class VII onwards)

Names of the Schools and Colleges Years of Study

12. Mention briefly the outstanding talents /

achievements, ifany : __________________________________

a) In Sports andGames :

b) In Co-curricular and
extra-curricularactivities

13. DoyourequireHostelaccommodation Yes /No

Ragging is prohibited in this Institution. The rules framed under “A.P.Prohibition of Ragging Act,
1997”will be implemented against all those who violate the Act and Rules.

DECLARATION BY THE APPLICANT

I declare that all the above particulars are true and correct. Should any information given above prove false at a
later date or if the admission is made contrary to rules, I agree to forfeit my admission. I agree to abide by the
rules and regulations of the College and University in force from time to time. Further, I agree to abide by the
decisions of Selection Committee in the matters of selection and that of Management and Principal of the
College, after admission, in matters of my misconduct or misbehavior or breach of rules. I agree to take my
T.C. and leave the College at anytime if my progress or conduct is not found satisfactory to the College
authorities. If I discontinue my studies in the middle for any reason, I abide by the rules of the college to
discontinue mid-way.

Station: Signature of the Applicant

Date :

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 DECLARATION BY THE PARENT / GUARDIAN

I certify that the particulars given by my son / daughter / ward are true and correct. I agree that my son /

daughter / ward would forfeit admission if any information given above is proved to be false at a later date or

if the admission is made contrary to rules. I agree for his / her admission into the College and I shall be

responsible for the payment of all the fees and other charges due from him / her for his / her studies. I shall

also hold myself responsible and compensate for any damages caused by my son / daughter in the college. I

shall be responsible for his / her good behaviour and I agree to abide by the decision of the college

authorities in matters of misconduct or misbehaviour or breach of rules by my son / daughter / ward and I

shall withdraw him / her from the college if the authorities are not satisfied with his / her progress / conduct

without any claims.

Station

Date
Signature of the Parent / Guardian

Check list:

Attested Photostat copies of the following certificates should be attached with the filled up application form.

i) Certified copy of Class X or any equivalent examination showing date of birth and other particulars of the
applicant.
ii) Certified copies of Pass certificate and Memorandum of Marks of the qualifying examination making eligible
foradmission.
Study & Conduct Certificate.
Transfer Certificate from the institution where last studied
Migration Certificate (lf applicable)
Equivalence Certificate (if applicable)
EAPCET Hall Ticket (if appeared)
EAPCET Rank Card ( if qualified)
JEE MAINS/AIEEE Marks
Passport and VISA of the Applicant
Affidavit to establish that he/she is a child/ward of a bona fide NRI
Address and photo proof of NRIsponsorer.
xiii) Other documents / annexures as listed in the brochure
xiv) Passport Size Photographs – 4 Nos.

Note: The hard copy of this application form should be submitted in personalong with the
documents mentioned in the list of documents in College office or through e-mail.

Last Date for submission of duly filled-in Application form to the College along with enclosures: 4.00 p.m. on
15.09.2021.

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 TO BE FILLED — IN BY THE OFFICE

Received originals and copies of the following

1) Date of Birth or Class X (SSC) Certificate or Equivalent

2) a) Pass Certificate

2) b)MarksStatements (Qualifyingexamination)

3) Study & ConductCertificate

4) TransferCertificate

5) MigrationCertificate

6) EquivalencyCertificate
(Applicable to those who have not passed Intermediate Examination in Andhra Pradesh).
7) EAPCET Hall Ticket (if appeared)
8) EAPCET Rank Card (if qualified)
9) JEE Mains / AIEEE Hall Ticket (if appeared)
10) JEE Mains / AIEEE Hall Ticket (if qualified)

11) Passport and VISA of Applicant (copiesonly)

12) Affidavit to establish that he/she is a child/ward of a bona fideNRI

13) Photo proof , Address and occupation proof of NRIsponsorer

14) Other documents / annexures as specified, if any.

Checked the above information and found correct. Checked and found that the application is properly
registered and is in order.

Date: Initials of theVerifyingAssistant Initials of the HEAD,ADMISSIONS

Date of Interview / Counselling:

Whether selected
in the Interview Yes / No

If wait listed, No. in

the waitlist

Initials of the Verifying Assistant Initials of the HEAD, ADMISSIONS

ADMITTED

Date : PRINCIPAL