MBITS

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IPCE19

Institution Code MBI

MAR BASELIOS INSTITUTE OF TECHNOLOGY AND SCIENCE [MBITS]

(Affiliated to APJ Abdul Kalam Technological University, Thiruvananthapuram & Approved by AICTE, New Delhi) Nellimattom P.O., Kothamangalam, Ernakulam District, Kerala, lndia. Pin: 686 693

Phone: 0485 - 2837 801 (30 Lines), Fax : 0485-2837 830

E-mail: info@mbits.edu.in, Website : www.mbits.edu.in

B.Tech Management /NRI Quota Admission Booking - Year 2019

PERSONAl Informations

Name of the Applicant
( in capital letters )

Date of Birth

Age

Gender

Name of Mother

Passport Size Photo (413*531px,100-500kb)

Occupation

Name of Father

Occupation

Blood Group

House Name

Post office

District

Pincode

Mobile No : Student

Mobile No : Parent

Land Phone Number

Religion

Caste

Community

Whether Mar Thoma Cheria Pally parish member?

Yes

Annual family income

EDUCATIONAL QUALIFICATIONS

Examination	Board/University	Year-Month of passing (YYYY-MM)	Name of lnstitution	Marks Secured/ Total Marks	Percentage
SSLC
PLUS 2
Diploma

PLUS 2	PCM Total %	Physics %	Chemistry %	Maths %	No. of A+	No. of A
PLUS 2

Engineering Entrance Exam	KEAM	KEE	JEE
Rank
Score

BRANCH PREFERENCE

DECLARATION

We hereby declare that the particulars given in this application are true to the best of our knowledge. We understand and agree that refund of booking amount will not be permitted.

Place : Nellimattom

Date

Signature of the
student

Attach

No File Choosen (200*200px)

Signature of the
parent/guardian

Attach

No File Choosen (200*200px)

Referred by

For Admission
90610 62801 , 90610 63801

B.Tech Application form