7/4/2016

RegistrationForm
Date:472016

Home
::OnLineRegistrationForm::

::CANDIDATEDETAILS
Name: AMIRMAHMADABIDSABIRMAHMAD

Course: DiplomaToDegreeEngineering

UserId: DD17496

DateofBirth: 08Dec1996

Board: GTU

PassingCourse: CivilEngineering

::BASIC DETAILS
Gender :
Category :
SubCategory :
TuitionFeeWaiverScheme :

Male

Female

OpenGeneral
Other

Transgender
SC

ST

SEBC

In/ExServiceman

OpenEWS

PhysicalHandicapped

IamInterested

IamNotInterested

FamilyAnnualIncome :
Mother'sName :

NAFISHASABIRMAHMADAMIR

Father'sName :

SABIRMAHMADABDULMAJIDAMIR

Nationatily :

Indian

Other

::10 THE XAMDETAILS

ExaminationBoard :

Gujarat

SeatNo./RollNo. :

B549009

MonthandYearofPassing :

03

CBSE

Other

2012

PER%DATACOMPULSARYSUBJECTS
Obtained

294

500

Outof

Per

58.8

::12 THSCIENCEE XAMDETAILS

HaveYouPassed12thScienceExam :

Yes

No

::DIPLOMAPASSINGDETAILS
DiplomaPassingBoard :
DiplomaPassingBranch :
EnrollmentNo/ExamNo/SeatNo./RollNo. :
MonthandYearofPassing :
DiplomaPassedState :

GTU
CivilEngineering

126380306576
03

2016

Gujarat

ObtainedOutof
STPI(LastTwoSem) :
CGPA :

10.4000

20

6.8200

10

::OTHER DETAILS
UserID :

DD17496

Passwordlengthmustbeof612charector,itmustbecombinationofAlphanumericwithspecialcharectorandoneCapitalletter
ForExample:Test@123
ChoosePassword* :

ConfirmPassword* :

http://gujacpcadm.nic.in/Candidate/Registration.aspx

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7/4/2016

RegistrationForm
ContactAddress* :

ASHIYANA,
OPP.RLY.LOCOSHED,
POLICEH.Q.ROADABRAMA.

City :
District :
Taluka :
PinCode :

VALSAD

Valsad

VALSAD

396001

ContactNo. : STDCode
MobileNo.* :
EMailAddress :

PhoneNo

8460003127

abida887@gmail.com

DECLARATIONOFTHECANDIDATE
Idoherebydeclarethatalltheparticularsindicatedabovearetrueandcorrecttothebestofmyknowledgeandbelief.IhavereadtheAdmissionRulesandInformation
Brochure,andIshallabidebyalltherulesandothertermsandconditionsforadmission.Intheeventofsuppressionordistortionofanyinformationprovidedbyme,I
understandthatadmissiongrantedbytheAdmissionCommitteeshallbeliableforcancellation.IalsounderstandthatthedecisionoftheAdmissionCommitteeregarding
myadmissionshallbefinalandIshallbeliablebyitsdecision.Further,Ifaddmitted,Ipromisetoabidebytherulesandregulationsoftheinstituteasapplicableduring
thecourseofstudy.Iamalsoawarethatraggingisbannedandif,foundguilty,Ishallbeliableforpunishmentsundertherules.Iabidetopaythefeesasdetermined
bytheFeeRegulatoryCommittee/stateGovt.

Iaccept

SUBMITREGISTRATIONDETAILS

IDecline

http://gujacpcadm.nic.in/Candidate/Registration.aspx

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