Enquiry Form
 
 

INTERNATIONAL INSTITUTE OF TECHNOLOGY & MANAGEMENT
49th km. stone, G.T. Karnal Road (NH‐1), Murthal-131039, Distt. Sonepat

Application Form For     
1. Name (In Block Letter) (As in Matric Certificate)    
2. Date of Birth (As per Matric Certificate)  
3. Nationality  
4. Gender  
5. Father’s Name  
6. Mother’s Name  
7. Occupation of Father/Guardian  
8. Annual Income  
9. Permanent Address with Pin No. Address of Communication
   
Ph.No. with STD Code:   Mobile No.:       E-Mail ID:      
10. Community: (√)  
11. Detail in Qualifying Examination (M.Tech.)
Programme Institution Board Month & Year of Passing % of Marks Division
B.Tech
12. Detail in Qualifying Examination (B.Tech.)
Programme Institution Board Month & Year of Passing % of Marks Division
X
XII/Diploma
12.1. Marks in Qualifying Examination for B.Tech
Subject Maximum Marks Marks Obtained Percentage of Marks
Physics 100
Chem./Comp. Sci 100
Math 100
Total 300
13 Detail in Qualifying Examination (BBA/BCA)
Programme Institution Board Month & Year of Passing % of Marks Division
X
XII/Diploma
13.1. Marks in Qualifying Examination for BBA/BCA
Subject % age Required for BBA Marks Obtained Percentage of Marks
XII(Any Stream) 45%---BBA
XII(Any Stream With Math) 50%---BCA
14. Detail in Qualifying Examination (POLYTECHNIC IN ME / CE/EE)
Programme Institution Board Month & Year of Passing % of Marks Division
X
XII/ITI
15. Rank in Entrance Exam (Maintain State & AIEEE): State Rank: AIEEE Rank:
16. Branch Opted in the order of Preference
Choice Code Code Branch
1 1 Mechanical Engineering (B.Tech./M.Tech.)
2 2 Computer Science & Engineering (B.Tech./M.Tech.)
3 3 Electrical Engineering (B.Tech.)
4 4 Electronics & Communication Engineering (B.Tech.)
5 5 Civil Engineering (B.Tech.)
6 6 Mechanical Engineering (Diploma)
7 7 Civil Engineering (Diploma)
8 8 BBA
9 9 BCA
17. Detail of Cheque/DD
Cheque/DD. No.  Dated: 
Payable At: 
18. VISIT THROUGH BY : (√)