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INDIAN INSTITUTE OF TECHNOLOGY, KANPURApplication Form For Admissions To Post Graduate 2014-2015

Date:10-APR-2014

Reference No: IITK/2014-15-I/PG/8500

Application Date: 10-APR-2014

Application Status: Submitted

1. General Information

Full Name HARISH KUMAR TALETIA DOB 30-MAY-1988

Place of Birth KOTA Sex Male Marital Status Single

Father's Name ARJUN KUMAR TALETIA Nationality Indian

Address for Corres. 380/7,keshavpura

State Rajasthan PinCode 324009

E-Mail h.k.taletia@gmail.com Phone NA Mobile 9660769684

2. Demand Draft Details

DD No. 8761 Amount Rs. 200.0 DD Date 10-APR-2014

Issued by Bank Name ICICI BANK Branch Code(Drawee) 006871

3. Applied Department/Programme Details and Category

Department Ind and Management Engg. Admission for Degree MTech Student Status Full Time

Appling directly PhD after BE/BTech from Centrally Funded Technical Institute NA

Financial Status Institute Asst Req. Category SC Phy. Handicapped No

Areas of specialization in the Department/Programme

Pref. 1. Production and Operations Management Pref. 2.

Pref. 3. Pref. 4.

4. Academic Information/Work Experience

A. GATE,ICMR-JRF,ICAR,DBT-JRF,CEED,CSIR-JRF/LS,UGC-JRF/LS,Other Fellowship Details

Exam Name Exam Discipline Score Rank Exam Year

GATE Production and Industrial Engg. 299.0 573 2014

B. Qualifying Degree already obtained or in Progress

University Name Uni Address 1 Uni Address 2 Rank in University Total Student in Uni

Rajasthan Technical University Rajasthan Technical University NA NA

Institute Code Institute Name & Place Centrally Funded Technical Inst. (Only

applicable for direct PhD after BE/BTech)

Rank in Institute

RJ024 Engineering College, Kota NA NA

Degree Discipline Year of Completed

Gradution

Min. Pass Marks Max. Marks

B.Tech. Production and Industrial Engineering 2013 25.0 100.0

% Marks or Grade

Average

Sem. I Sem. II Sem. III Sem. IV Overall/Current

grade average55.4 0.0 53.9 55.0

Sem. V Sem. VI Sem. VII Sem. VIII57.0

56.7 58.4 53.1 65.5

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C. Other Degrees Obtained after 10+2(Do not include the degree listed in 4B)

Degree Discipline University Name & Address Institute Name & Address Marks or

CPI

Completio

n Year

D. Working Experiences

Duration Employer Position Nature of work

E. Number of Technical Papers(Provide details separately)

Papers Published in Journals 0 Presented in Conference 0

5. Names and addresses of two referees from whom letters of reference have been obtaioned(For Ph.D Only)

1. 2.

Address: Address:

Email: Email:

Declaration by the Applicant

Certified that all information provided by me in this form is correct to the best of my knowledge and belief. I understand that any wilful misrepresentation of facts

will result in my dismissal from the institute. If admitted, I shall abide by all the rules and regulations of the institute.

Date: Signature:

Checklist (Send self attested photocopies(Not Original) and mention reference no. on each of the document)

1. Date of Birth (DOB) Certificate or High School (Class 10) Certificate with

DOB

2. SC/ST/OBC Certificate if applicable

3. Certificate of Physical Disability (Type of disability to be attached) 4. Sponsorship Certificate for Sponsored Candidate

5. GATE/CSIR/UGC/ICMR/CEED/Other Fellow Exam Score card (If you have

not received GATE score card then please send printout of the online GATE

score card.)

6. Photocopies of qualifying degree marks/grade sheets

7. The application fee of Rs.400/ for candidates in General/OBC and Rs.200/ for

SC/ST/PD must be paid through demand draft payable to The Registrar IIT

Kanpur at Kanpur.(Note: Send original)

8. Printed copy of your Online filled application form (If photograph is not

loaded, then write reference no at back of self attested passport size photograph

and staple it.).

9. No Objection/relieving Certificate from Employer (For employed candidates

at the time of admission)

10. Two letters of reference (For Ph.D. applicants only)

11. For applicants to the PhD programme of the ME Department, please see http://www.iitk.ac.in/me/admission/phd2014.htm for additional mandatory

requirements

Mailing Address for Applications:

The Convenor, DPGC

Department/Programme of _________________________

(Kindly mentioned the Department name where you are seeking your admission)

Indian Institute of Technology, Kanpur

Kanpur-208016 U.P.