Instruction for Candidate:-

1. There are 4 sheets in this file.

2. This sheet (Sheet - 1) to be retained by you carefully.
3. Your Login id is SHRI2412
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 DELHI 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. 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).
8. Insert completed Application Form with enclosures (if any) into A4 size cover, without folding.
9. Sheet - 4 contain the address of the IIT DELHI ZONE
to which the application form needs to be posted.
10. Stick the Sheet-4 on top of 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: A321002358 Zone: IIT DELHI ZONE

1. Name of the Candidate as in SHRISHTI GUPTA 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 SHARAD KUMAR GUPTA
as in 10th Class Certificate 21. Counselling IIT DELHI COUNSELLING

22. Place of 10th Schooling CITY

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

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 Public / Govt Service
Occupation
6. Gender FEMALE 26. Parent's / Guardian's Total Rs.6,00,000 - 10,00,000
Annual Income
7. Nationality INDIAN 27. Fee Amount Rs. 450

8. Date of Birth (DD/MM/YYYY) 24/12/1992 11. Board of Qualifying CBSE

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 212 - Gautam Budh Nagar(Noida)
Class or Equivalent Center 201 - Delhi(East)
If Appeared more than once, 14. Pincode or Permanent 201301
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 / SHARAD KUMAR GUPTA Signature of the Candidate
Guardian

Name of the Student SHRISHTI GUPTA

Countersigned by Parent / Guardian

15. Address:- C-496

SECTOR-19 Please write

your name and
NOIDA application
number on the
GAUTAM BUDH NAGAR back of photo
before affixing
16. Phone / Mobile 09899006567
Number
17. Pincode 201301
18. E-Mail Address guptaksharad@gmail.com

Signature(within box) in running hand using

A321002358 black ball point pen only (do not sign in capitals)
Send this form along with the necessary documents to IIT DELHI ZONE

Sheet - 2
IIT JEE 2010 APPLICATION FORM STUDENT COPY
APPLICATION FORM FOR JOINT ENTRANCE EXAMINATION - 2010
Application No: A321002358 Zone: IIT DELHI ZONE

1. Name of the Candidate as in SHRISHTI GUPTA 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 SHARAD KUMAR GUPTA
as in 10th Class Certificate 21. Counselling IIT DELHI COUNSELLING

22. Place of 10th Schooling CITY

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

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 Public / Govt Service
Occupation
6. Gender FEMALE 26. Parent's / Guardian's Total Rs.6,00,000 - 10,00,000
Annual Income
7. Nationality INDIAN 27. Fee Amount Rs. 450

8. Date of Birth (DD/MM/YYYY) 24/12/1992 11. Board of Qualifying CBSE

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 212 - Gautam Budh Nagar(Noida)
Class or Equivalent Center 201 - Delhi(East)
If Appeared more than once, 14. Pincode or Permanent 201301
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 / SHARAD KUMAR GUPTA Signature of the Candidate
Guardian

Name of the Student SHRISHTI GUPTA

Countersigned by Parent / Guardian

15. Address:- C-496

SECTOR-19 Please write

your name and
NOIDA application
number on the
GAUTAM BUDH NAGAR back of photo
before affixing
16. Phone / Mobile 09899006567
Number
17. Pincode 201301
18. E-Mail Address guptaksharad@gmail.com

Signature(within box) in running hand using

A321002358 black ball point pen only (do not sign in capitals)
Retain this form for your reference

Sheet - 3
APPLICATION FORM NO A 3 2 1 0 0 2 3 5 8 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 212 201

(See Appendix-III in the Information Brochure)

To
From
Name SHRISHTI GUPTA
The Chairman
Address Joint Entrance Examination - 2010
Indian Institute of Technology - IIT DELHI ZONE
C-496

SECTOR-19 THE CHAIRMAN,

NOIDA JEE - 2010

GAUTAM BUDH NAGAR IIT DELHI

DELHI
Pin 2 0 1 3 0 1

Phone/Mobile: 09899006567
Email (if any) : guptaksharad@gmail.com Pin 1 1 0 0 1 6

Sheet - 4