NATIONAL INSTITUTE OF TECHNOLOGY PATNA (An Institute under Ministry of HRD, Govt. of India) 

ASHOK RAJPATH, PATNA‐800 005 (BIHAR) 

15.07.2016

NOTICE

Sub: Admission in UG Programme at NIT Patna through JoSAA-2016

Candidates who have got a seat at NIT Patna through JoSAA-2016 are required to report at NIT Patna, Computer Centre during 22.07.2016 to 26.07.2016 for the completion of formalities related to admission in the First semester of academic session 2016-17. They are required to produce the following documents (original) and submit one set of self-attested documents at the time of admission.

Two colour Photographs Admission form duly filled as per attached format Document verification cum seat acceptance letter.

Provisional seat allotment letter after sixth round.

Class Xth certificate for proof of DoB.

Class XIIth certificate and Marksheet.

Migration certificate in original from last attended institute.

Affidavit for Gap year, if any.

Medical Certificate in prescribed format as displayed on Institute website.

PwD certificate, if required

Affidavit by student and guardian regarding Anti- Ragging, as displayed on Institute website.

Category certificate, if required.

Income certificate issued by Revenue Officer not below the rank of Tahsildar, if required.

Fee will be deposited through e-challan which will be issued by the Institute at the time of reporting for admission at NIT Patna. For different categories fees to be paid is mentioned in the following Table.

Table S. No.

Category Fees to be paid for B.Tech & Integrated M.Sc course

Fees to be paid for Arch. course

1. SC/ST/PwD ₹1,200/- ₹2,200/- 2. Economically Backward Student

(Parent’s income less than ₹1.0 Lakh per annum)

NIL NIL

3. Economically Backward Student (Parent’s income between ₹1.0 Lakh to ₹5.0 Lakh per annum)

NIL NIL

4. For others (Parent’s income more than ₹5.0 Lakh per annum)

₹38,700/- ₹39,700/-

Economically Backward students mentioned at S. No. 2&3 in the above table need not to pay the fees at the time of admission. They are required to submit cancelled cheque for refund of the difference amount. For S. No.-2 difference amount for B.Tech & Integrated M.Sc course is ₹23,800/- and for Arch. course is ₹22,800/-. For S. No. 3 difference amount for B.Tech & Integrated M.Sc course is ₹2,967/- and for Arch. course is ₹1,967/-.

(Prof. S. K. Verma)

PI (Admission)

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NATIONAL INSTITUTE OF TECHNOLOGY PATNA Ashok Rajpath, Patna-800005.Bihar.India

Application form for Admission to B. Tech. / B. Arch. / Integrated M.Sc. Program

Institute Roll No. (to be assigned by office)

PHOTOGRAPH Affix recent colored passport

size photograph

And Put your signature in box

provided below this space in Black pen

To be filled by the candidate in his/her own handwriting in Capital letters except signature

Details of fee paid E-challan No. Amount

JEE Mains 2016 Roll No. Category (Put √ mark)

JEE Mains 2016 Rank (All India) General

JEE Mains 2016 Rank (Category) OBC

JEE Mains Exam Subjects SC

ST

PwD

Resident of State: OCI/PIO

Blood Group

Allotted Course and Branch B. Tech./ B. Arch. / Integrated M. Sc. Program  

1. Name of candidate in full (as per 10th Certificate)

Name of candidate in Devnagari (Hindi)

2. Father’s Name

3. Mother’s Name

4. Guardian’s Name in full (if father is not alive)

5. Date of Birth (dd-mm-yyyy) Sex: Male / Female/Trans

6. Occupation of Parents Father: Mother:

Parent’s Income per annum from all sources

Organization where father/Mother/ Guardian (if father is not alive) is working

7 Correspondence Address

Pin Code:

Phone No. (with STD Code)/Mobile No.:

Email ID: 8. Permanent Address

Pin Code:

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9. Academic Details: Exam Branch / Specialization Institute / University Year of Passing

Matriculation/10th

Intermediate/12th

10. SGPA/CGPA/ % Marks: SGPA/ CGPA % Marks Overall % Marks

Matriculation/10th

Intermediate/12th

11. Declaration of the candidate: I,………………………………………………………….Son/Daughter of Sri…………………………………… Declare that : -

a) Information furnished above are correct and in case any of the information is found false or forged at any stage of my admission to and/or stay in the Institute, I shall be liable (i) to lose my candidature for admission to the program, (ii) for expulsion from the Institute if admitted and (iii) for appropriate legal action.

b) In the event of my being admitted to this Institution, I shall abide by all the rules and regulations of the Institute and the authority concerned.

c) I have submitted my qualifying examination passing certificate with the application form

OR

I will submit my qualifying examination passing certificate by the due date notified by the Institute, else my admission shall stand cancelled.

Place : ____________________

Full Signature of the Candidate in English

Date : ____________________

12. Declaration of the Father / Guardian: Candidates may submit the declaration of Father/Guardian in their own

handwriting separately even after admission if Father/Guardian is not available at the time of admission.

I,……………………………………………………. declare that in the event of Sri/Smt./Miss……………………

…………………………………………..being admitted to this Institution, I shall be responsible for his/her conduct and

undertake to pay all his/her Institute, Hostel, Mess and other dues regularly till the completion of his/her studies. I further

certify that the information furnished by him/her are correct.

Place : ____________________

Full Signature of the Father / Guardian

Date : ____________________

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Name of the candidate in full

Roll No. :

1. Self-attested Photocopies of following(as applicable) must be submitted at the time of Admission

(Put √ mark)

(i) CSAB Reporting letter and allotment letter

(ii) JEE (Mains) Score Card

(iii) Certificate of Category OBC/SC/ST, if applicable, issued by the competent authority

(iv) Income Certificate for OBC Candidates for claim with respect to Non creamy Layer issued by competent authority as per directive of the MHRD. (If seat allotted in OBC-NCL Category )

(v) Certificate for Person with disabilities

(vi) Class X (High School) Board Certificate as proof of Date of Birth

(vii) Class X Marks Sheet

(viii) Qualifying Examination (XII) Marks Sheet

(ix) Qualifying Examination passing certificate (as applicable for the program). In case it is not being submitted then undertaking for submission by due date fixed by Institute.

(x) Affidavit with respect to Gap year (i.e. reason for discontinuity between passing year of qualifying examination and year of admission to B. Tech/ B. Arch/ Integrated M. Sc program.)

(xi) Income certificate of parent issued by revenue officer not below the rank of Tahsildar.

(xii) Two copies of colored Photograph. (identical to one pasted on the application

form)

(xiii) Migration certificate from the University/ Deemed University/ Institute last

Attended

(xiv) E-challan for balanced fee payment.

2. Signature of documents Verifying officer (s):

1………………………………. 2……………………………….. 3. ……………………………..

(To be obtained at the time of admission in presence of Institute representative only) 3. Full Signature of the Candidate: (English)

Left Thumb impression of the Candidate

Signature of Admission-In-Charge of the Institute

NATIONAL INSTITUTE OF TECHNOLOGY PATNA

(An Institute under Ministry of HRD, Govt. of India)

ASHOK RAJPATH, PATNA-800 005 (BIHAR)

…………………………………………………………………………………….………………………………………………………………………………

MEDICAL EXAMINATION FOR PHYSICAL FITNESS

(To be obtained from any Registered Medical Practitioner)

Name: ………............................................................. S/O........................................................................................

I. General Examination: …………….. ……… Height …………cms. Weight ………....Kgs.

II. C.V.S. : Pulse: ……………/ Minute; Regular / Irregular B.P.: …………………………..

III. Respiratory System: ……………………………………………………………………………………..

IV. GI System: ………………………………………………………………………………………………

V. Musculoskeletal System : Normal / Disabled (If disabled refer to a specialist)

VI. Skin: ………………………………………………………………………………………………….….

VII. Examination of Eyes: Normal / Defective: ……………………… Spectacles………………………….

(If any abnormality is found, refer to the specialist)

VIII. E.N.T.: Normal / Abnormal: …………………………………..

(If any abnormality is found, refer to the specialist)

IX. C.N.S.: ………………………………………………………………………….……………………….

X. G.U.S.: …………………………………………………………………………………………………..

XI. Female Candidate: Menstrual History: ………………………………………………………………….

XII. Blood Group & Rh: ……………………………………………………………………………………..

I do hereby certify that I have examined the above candidate for admission to ……………………….. Programme

in National Institute of Technology Patna, ………………………… department and cannot discover that he / she

has any disease and constitutional defect or bodily infirmity except that

……………………………………………… I do not consider this as a disqualification for undergoing the above

programme. His / Her age according to his/her own statement is ………………………. years and by appearance

……………. years.

Personal Marks of Identification:

1…………………………………………………………….……..

2……………………………………………………………………

Date:

Place: Signature of Doctor

(With seal & Regd.No.)

(* Any defect to be noted in Detail)_____________________________________________________________

__________________________________________________________________________________________

NATIONAL INSTITUTE OF TECHNOLOGY PATNA

(An Institute under Ministry of HRD, Govt. of India, New Delhi) ASHOK RAJPATH, PATNA-800 005 (BIHAR)

………………………………………………………………………………………………………………………………………………………........................

CERTIFICATE OF PHYSICAL FITNESS (Declaration by the candidate for the issue of Physical Fitness Certificate)

Name: …………………………………………………………… Male/Female Branch: …………………………

Date of Birth: Age (in years):

Address: ………………………………………………………………………………………………………………

………………………………………………………………………………………………………………..

Indicate your response by Y/N (Y means Yes; N means No)

Do you have any minor or major complaint?

If yes, describe …………………………………………………………………………

Are you allergic to any medicine or any others?

If yes, describe …………………………………………………………………………

Have you ever been affected with?

Small Pox, Chicken Pox Asthma

Intermittent or any fever Epilepsy

Enlargement or suppuration of glands Appendicitis

Spitting of Blood Lungs Disease

Heart Disease Rheumatism

Fainting Attacks Any Other ……………………

Have you ever had any operation or been advised any operation?

If yes, describe …………………………………………………………………………………………..

Are you handicapped? Visual / Hearing / Orthopedic

Immunization had: BCG OPV DPT M.M.R. ……………

Preventive vaccination (Please tick):

Chicken Pox Typhoid Hepatitis-B

Rubella (F) Any other (specify)…………………………

Blood Group & Rh ………………………………………………………………………………………………….

Personal Marks of Identification: 1...……………………………………………………………………………….

2. …………………………………………………………………………………

I declare that all the above information are true and to the best of my knowledge.

Signature of the Candidate

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AFFIDAVIT BY THE STUDENT

I, _____________ ___________________________ _________________ (full name of student with

admission/ registration/ enrolment number) s/o d/o Mr./Mrs./Ms. _______ ____ ________ _______________ _________________ , having been admitted to National Institute of Technology Patna (name of the

institution) , have received a copy of the UGC Regulations on Curbing the Menace of Ragging in Higher Educational Institutions, 2009, (hereinafter called the “Regulations”) carefully read and fully understood the provisions contained in the said Regulations.

2) I have, in particular, perused clause 3 of the Regulations and am aware as to what constitutes ragging.

3) I have also, in particular, perused clause 7 and clause 9.1 of the Regulations and am fully aware of the penal and administrative action that is liable to be taken against me in case I am found guilty of or abetting ragging, actively or passively, or being part of a conspiracy to promote ragging.

4) I hereby solemnly aver and undertake that

a) I will not indulge in any behavior or act that may be constituted as ragging under clause 3 of the Regulations.

b) I will not participate in or abet or propagate through any act of commission or omission that may be constituted as ragging under clause 3 of the Regulations.

5) I hereby affirm that, if found guilty of ragging, I am liable for punishment according to clause 9.1 of the Regulations, without prejudice to any other criminal action that may be taken against me under any penal law or any law for the time being in force.

6) I hereby declare that I have not been expelled or debarred from admission in any institution in the country on account of being found guilty of, abetting or being part of a conspiracy to promote, ragging; and further affirm that, in case the declaration is found to be untrue, I am aware that my admission is liable to be cancelled.

Declared this ___day of __________ month of ______year.

_________________________ Signature of deponent

Name: __________ __________ ___________

VERIFICATION

Verified that the contents of this affidavit are true to the best of my knowledge and no part of the affidavit is false and nothing has been concealed or misstated therein.

Verified at ____________ (place) on this the _____ (day) of_______ (month) , _________ (year ) .

________________ Signature of deponent

Solemnly affirmed and signed in my presence on this the (day) of (month), (year) after reading the contents of this affidavit.

OATH COMMISSIONER

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AFFIDAVIT BY PARENT/GUARDIAN

I, Mr./Mrs./Ms. _________________ __________________ __________________ (full name of

parent/guardian) father/ mother/ guardian of , __________ ________ _______ _______ ____ (full name of

student with admission/ registration/ enrolment number) , having been admitted to National Institute of

Technology Patna (name of the institution) , have received a copy of the UGC Regulations on Curbing the Menace of Ragging in Higher Educational Institutions, 2009, (hereinafter called the “Regulations”), carefully read and fully understood the provisions contained in the said Regulations.

2) I have, in particular, perused clause 3 of the Regulations and am aware as to what constitutes ragging.

3) I have also, in particular, perused clause 7 and clause 9.1 of the Regulations and am fully aware of the penal and administrative action that is liable to be taken against my ward in case he/she is found guilty of or abetting ragging, actively or passively, or being part of a conspiracy to promote ragging.

4) I hereby solemnly aver and undertake that

a) My ward will not indulge in any behaviour or act that may be constituted as ragging under clause 3 of the Regulations.

b) My ward will not participate in or abet or propagate through any act of commission or omission that may be constituted as ragging under clause 3 of the Regulations.

5) I hereby affirm that, if found guilty of ragging, my ward is liable for punishment according to clause 9.1 of the Regulations, without prejudice to any other criminal action that may be taken against my ward under any penal law or any law for the time being in force.

6) I hereby declare that my ward has not been expelled or debarred from admission in any institution in the country on account of being found guilty of, abetting or being part of a conspiracy to promote, ragging; and further affirm that, in case the declaration is found to be untrue, the admission of my ward is liable to be cancelled.

Declared this ____ day of __________ month of _______ year.

_____________________ Signature of deponent

Name: __________________________________________ Address:_________________________________________ Telephone/ Mobile No.: ____________________________

VERIFICATION

Verified that the contents of this affidavit are true to the best of my knowledge and no part of the affidavit is false and nothing has been concealed or misstated therein.

Verified at __________ (place) on this the ___ (day) of _________ (month) , __________ (year ) .

____________ ________________ Signature of deponent

Solemnly affirmed and signed in my presence on this the ___ (day) of ________ (month) __________ (year ) after reading the contents of this affidavit.

OATH COMMISSIONER