Visvesvaraya National Institute of Technology, Nagpur - 440010
Visvesvaraya National Institute of Technology, Nagpur - 440010
Visvesvaraya National Institute of Technology, Nagpur - 440010
Name of the
Industry/Organisation:_________________________________________________________________
___
1. GENERAL
1.1 Name: __________________ _______________________
____________________________
Surname First Name Father’s Name
1.2 Date of Birth :
Day Month Year
1.3 Height : ___________ cms. Weight : ____________ kg.
1.4 Present Address :
__________________________________________________________________
_____________________________________ PIN
1.5 Address for Correspondence:
________________________________________________________
(after annual examination) ____________________________________
________________________________ PIN
Phone (R) ______________________
1.6 E-Mail Address : _____________________________ Mobile
No.__________________________
2. EDUCATIONAL QUALIFICATIONS
2.1 Secondary and / or Higher Secondary
Examinati Board / Institution Year of Marks
on Passing Obtained Out of %
(Total)
S.S.C. or
Equivalent
H.S.S.C. or
Equivalent
Brothers
Sisters
4. PRACTICAL TRAINING
Have you undergone practical training? Yes No.
If yes, provide details below
Period
Sr. Name of Organisation
No. From To