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Form-1

INDIAN INSTITUTE OF TECHNOLOGY BHUBANESWAR


BHUBANESWAR-751013


Statement of Acceptance


Name :
Application No :
GATE Registration No :
Name of the Course alloted :

I accept the above mentined course allotted to me


Accept the offer Accepted with upgradation Reject the offer
(No upgradation will be allowed) (upgradation is allowed in 2
nd
and 3
rd
list)

(Note: Please tick one of the boxes above)



Date: (Signature of the Candidate)


Please mention your current postal address.













E- Mail id:
Mobile No:
Return the filled form to:

Officer-on-Special Duty (Academic Affairs)
Indian Institute of Technology Bhubaneswar
Samantapuri
Bhubaneswar-751013 (Odisha)

Form-2

INDIAN INSTITUTE OF TECHNOLOGY BHUBANESWAR
BHUBANESWAR-751013



PRE-REGISTRATION DEMAND DRAFT DETAILS


Please find enclosed a demand draft of Rs. 10,000/- dated ______________________________ in favour of
IIT Bhubaneswar payable at Bhubaneswar.

Demand Draft No : __________________________________________________
Name of the issuing Bank : __________________________________________________
Place : __________________________________________________




Date: Signature of the Candidate











Return the filled form to:


Officer-on-Special Duty (Academic Affairs)
Indian Institute of Technology Bhubaneswar
Samantapuri
Bhubaneswar-751013 (Odisha)