Instruction for Candidate:-

1. There are 5 sheets in this file.

2. This sheet (Sheet - 1) to be retained by you carefully.
3. Your Login id is MVPH3103
4. Remember your password and do not disclose to anyone.
5. Sheet - 2 is the Application Form to be sent by Registered / Speed Post only to IIT MADRAS ZONE
a. Stick your color photo in designated place.
b. Put your signature at designated place.
c. Request your Parent / Guardian to sign at designated place.
6. Sheet - 3 is Application Form to be retained by you for your reference.
7. Sheet - 5 has three copies of bank challan. Take it to bank and pay the fees.
Bank will retain a copy with them and will return two copies to you. In those two copies, retain the STUDENT copy
with you and attach the IIT copy with application form.
8. Attach attested copies of SSLC certificate where your date of birth is mentioned clearly, and all other applicable
certificates (SC/ST/PD/DS/Enlarged Font request).
9. Insert completed Application Form with enclosures (if any) into A4 size cover, without folding.
10. Sheet - 4 contain the address of the IIT MADRAS ZONE
to which the application form needs to be posted.
11. Stick the Sheet-4 on top the A4 size cover and post it.

Sheet - 1
IIT JEE 2010 APPLICATION FORM IIT COPY
APPLICATION FORM FOR JOINT ENTRANCE EXAMINATION - 2010
Application No: A361021350 Zone: IIT MADRAS ZONE

1. Name of the Candidate as in M V PHANI DEEPTHI 19. This Attempt at JEE FIRST
the 10th Class Certificate
Year of First Attempt

20. Type of Preparation SELF STUDY

2. Name of the one Parent / Guardian M V RAMANA RAO
as in 10th Class Certificate 21. Counselling IIT MADRAS COUNSELLING

22. Place of 10th Schooling CITY

3. Relationship of Person at FATHER 23. Mother Tongue Telugu

S.No.2 with the Candidate
24. Parent's / Guardian's BOTH PARENTS GRADUATE
4. Category GE
Educational Background
5. Sub Category None
Type of Disablity 25. Parent's / Guardian's Law Practice
Occupation
6. Gender FEMALE 26. Parent's / Guardian's Total Rs.3,00,000 - 6,00,000
Annual Income
7. Nationality INDIAN 27. Fee Amount Rs. 450

8. Date of Birth (DD/MM/YYYY) 31/03/1993 11. Board of Qualifying STATE BOARD

Examination
9. Year of passing 10th Class 2008 12. Question Paper Language ENGLISH
or Equivalent
10. Year of Passing 10+2 Appearing in 2010 13. Choice of Examination 602 - Hyderabad
Class or Equivalent Center 606 - Warangal
If Appeared more than once, 14. Pincode or Permanent 500007
Year of passing with min Marks Place of Residence
I hereby declare that all the particulars stated in this application form are true to the best of my knowledge and belief. I have read the
Information Brochure and I shall abide by the terms and conditions therein. I also certify that I have not appreared in JEE in 2008 or earlier
and have not accepted admission by paying full fees at any of the IITs, IT-BHU or ISM. In the event of suppression or distortion of any fact
regarding the eligibility criteria, nationality, etc., in my application form, I understand that I will be denied the opportunity to appear in JEE
and if already admitted, my admission / degree acquired is liable for cancellation. I also understand that the decision of the Joint
Admission Board regarding my admission to IITs/IT-BHU/ISM is final and I shall abide by the decision. Further, if admitted, I promise to
abide by the rules and norms of discipline of the Institute I join.

Place:

Date:
Name of the Parent / M V RAMANA RAO Signature of the Candidate
Guardian

Name of the Student M V PHANI DEEPTHI

Countersigned by Parent / Guardian

15. Address:- H.NO 9-41/1, RAVINDER NAGAR,HABSIGUDA, HYDERABAD

Please write
your name and
application
number on the
back of photo
16. Phone / Mobile 09440154259 before affixing
Number
17. Pincode 500007
18. E-Mail Address marripati_phani@yahoo.com

Signature(within box) in running hand using

A361021350 black ball point pen only (do not sign in capitals)
Send this form along with the necessary documents to IIT MADRAS ZONE

Sheet - 2
IIT JEE 2010 APPLICATION FORM STUDENT COPY
APPLICATION FORM FOR JOINT ENTRANCE EXAMINATION - 2010
Application No: A361021350 Zone: IIT MADRAS ZONE

1. Name of the Candidate as in M V PHANI DEEPTHI 19. This Attempt at JEE FIRST
the 10th Class Certificate
Year of First Attempt

20. Type of Preparation SELF STUDY

2. Name of the one Parent / Guardian M V RAMANA RAO
as in 10th Class Certificate 21. Counselling IIT MADRAS COUNSELLING

22. Place of 10th Schooling CITY

3. Relationship of Person at FATHER 23. Mother Tongue Telugu

S.No.2 with the Candidate
24. Parent's / Guardian's BOTH PARENTS GRADUATE
4. Category GE
Educational Background
5. Sub Category None
Type of Disablity 25. Parent's / Guardian's Law Practice
Occupation
6. Gender FEMALE 26. Parent's / Guardian's Total Rs.3,00,000 - 6,00,000
Annual Income
7. Nationality INDIAN 27. Fee Amount Rs. 450

8. Date of Birth (DD/MM/YYYY) 31/03/1993 11. Board of Qualifying STATE BOARD

Examination
9. Year of passing 10th Class 2008 12. Question Paper Language ENGLISH
or Equivalent
10. Year of Passing 10+2 Appearing in 2010 13. Choice of Examination 602 - Hyderabad
Class or Equivalent Center 606 - Warangal
If Appeared more than once, 14. Pincode or Permanent 500007
Year of passing with min Marks Place of Residence
I hereby declare that all the particulars stated in this application form are true to the best of my knowledge and belief. I have read the
Information Brochure and I shall abide by the terms and conditions therein. I also certify that I have not appreared in JEE in 2008 or earlier
and have not accepted admission by paying full fees at any of the IITs, IT-BHU or ISM. In the event of suppression or distortion of any fact
regarding the eligibility criteria, nationality, etc., in my application form, I understand that I will be denied the opportunity to appear in JEE
and if already admitted, my admission / degree acquired is liable for cancellation. I also understand that the decision of the Joint
Admission Board regarding my admission to IITs/IT-BHU/ISM is final and I shall abide by the decision. Further, if admitted, I promise to
abide by the rules and norms of discipline of the Institute I join.

Place:

Date:
Name of the Parent / M V RAMANA RAO Signature of the Candidate
Guardian

Name of the Student M V PHANI DEEPTHI

Countersigned by Parent / Guardian

15. Address:- H.NO 9-41/1, RAVINDER NAGAR,HABSIGUDA, HYDERABAD

Please write
your name and
application
number on the
back of photo
16. Phone / Mobile 09440154259 before affixing
Number
17. Pincode 500007
18. E-Mail Address marripati_phani@yahoo.com

Signature(within box) in running hand using

A361021350 black ball point pen only (do not sign in capitals)
Retain this form for your reference

Sheet - 3
APPLICATION FORM NO A 3 6 1 0 2 1 3 5 0 BY REGISTERED POST/
SPEED POST
FOR Rs. 450 /-

JEE - 2010
Indian Institutes of Technology

Your Choice Choice - I Choice - II

of Cities
for JEE - 2010 602 606

(See Appendix-III in the Information Brochure)

To
From
Name M V PHANI DEEPTHI
The Chairman
Address Joint Entrance Examination - 2010
Indian Institute of Technology - IIT MADRAS ZONE
H.NO 9-41/1, RAVINDER NAGAR,HABSIGUDA, HYDERABAD

THE CHAIRMAN,

JEE- 2010

IIT MADRAS

CHENNAI
Pin 5 0 0 0 0 7

Phone/Mobile: 09440154259
Email (if any) : marripati_phani@yahoo.com Pin 6 0 0 0 3 6

Sheet - 4
 STUDENT’S COPY
PAY IN SLIP BANK'S COPY PAY IN SLIP INSTITUTION’S COPY PAY IN SLIP

PAYABLE AT ALL BRANCHES OF PAYABLE AT ALL BRANCHES OF PAYABLE AT ALL BRANCHES OF

INDIAN BANK INDIAN BANK INDIAN BANK
Paid in to the credit of INDIAN INSTITUTE OF Paid in to the credit of INDIAN INSTITUTE OF Paid in to the credit of INDIAN INSTITUTE OF
TECHNOLOGY (MADRAS) A/C no 857353972 , ADYAR TECHNOLOGY (MADRAS) A/C no 857353972, ADYAR TECHNOLOGY (MADRAS) A/C no 857353972 , ADYAR
BRANCH CHENNAI, BRANCH CODE : 79 BRANCH CHENNAI, BRANCH CODE : 79 BRANCH CHENNAI, BRANCH CODE :79

Name of the Candidate M V PHANI DEEPTHI Name of the Candidate M V PHANI DEEPTHI Name of the Candidate M V PHANI DEEPTHI

Present Address H.NO 9-41/1, RAVINDER Present Address H . N O 9 - 4 1 / 1 , R A V I N D E R Present Address H . N O 9 - 4 1 / 1 , R A V I N D E R

in CAPITAL LETTERS NAGAR,HABSIGUDA, HYDERABAD - in CAPITAL LETTERS NAGAR,HABSIGUDA, HYDERABAD - in CAPITAL LETTERS NAGAR,HABSIGUDA, HYDERABAD -
with Pin Code 500007 with Pin Code 500007 with Pin Code 500007

Date of Birth 31/03/1993 Date of Birth 31/03/1993 Date of Birth 31/03/1993

Mobile / Landline No: 09440154259 Mobile / Landline No: 09440154259 Mobile / Landline No: 09440154259

E Mail ID marripati_phani@yahoo.com E Mail ID marripati_phani@yahoo.com E Mail ID marripati_phani@yahoo.com

Category : Female, GE:- Rs.480/- Category : Female, GE:- Rs.480/- Category : Female, GE:- Rs.480/-

Amount in words : Rupees Four Hundred And Eighty Only. Amount in words : Rupees Four Hundred And Eighty Only. Amount in words : Rupees Four Hundred And Eighty Only.
(*Inclusive of Bank Charge) (*Inclusive of Bank Charge) (*Inclusive of Bank Charge)
Name of the Name of the Name of the
Receiving Branch Receiving Branch Receiving Branch

Signature of the candidate Signature of the candidate Signature of the candidate

FOR BANK’S USE FOR BANK’S USE FOR BANK’S USE

Journal No: Branch Journal No: Branch Journal No: Branch

Code Code Code

Application A361021350 Signature Application A361021350 Signature Application A361021350 Signature

Number : of Number : of Number : of
cashier cashier cashier

Branch Date Branch Date Branch Date

Name Name Name