Form
No. :
BIJU PATNAIK NATIONAL STEEL INSTITUTE
Affix self
attested passport size photographs
ORSSSA –
762 001
APPLICATION FORM
Course
Applied for :
___________________________________________________
1.
Name in Block Letters :
_________________________________________________________
2. Father/ Guardian’s Name :
_________________________________________________________
3.
Relationship :
_________________________________________________________
(If other than father)
4.
Address for Communication :
_________________________________________________________
__________________________________________________________
__________________________________________________________
____________________________________Pin
__________________
Tel No. :
e-Mail :
5.
Permanent Address :
_________________________________________________________
__________________________________________________________
__________________________________________________________
____________________________________Pin
__________________
6.
Date of Birth : DD MM YYYY 7.
Age on :
_____ Years _______ Months
(
8.
Sex : Male Female 9. Nationality
: _______________________
10.
Category :
(Give a Tick Mark)
11.
Educational Qualification :
|
Examination Passed |
Board / University |
School / College / Istitution |
% age of Marks |
Year of Passing |
Class / Division |
Subject Taken |
|
10th
(Matric) |
|
|
|
|
|
|
|
+2
Sc.(Inter) |
|
|
|
|
|
|
|
Diploma
Engg. |
|
|
|
|
|
|
|
+3
Sc. (Degree) |
|
|
|
|
|
|
|
BE
/ B Tech. (Degree) |
|
|
|
|
|
|
|
Other
|
|
|
|
|
|
|
12.
Working Experience (If Any) :
(If space is not sufficient please
attach a
separate sheet)
13.
Extra Curricular Activities :
(Include any Professional Certificate)
DECLARATION
I, here by declare that the information
furnished above is true to best of my knowledge and belief. I understand that
any incorrect and incomplete information will disqualify my candidature.
Signature
of Candidate’ s Father / Guardian Signature of the
Candidate
Date
: Date
:
FOR OFFICE USE ONLY Received on :
Index
Number : Application Completed
: YES / NO All required Mark Sheets Enclosed : YES / NO Bank Draft Enclosed
: YES / NO Remarks if any :
Verified by
Enclosures
List
(Please
check the enclosures and make a tick mark in the enclosures)
1.
Xerox
copy of Matric Certificate
2.
Xerox
copy of Matric
Mark Sheets
3.
Xerox
copy of Intermediate Certificate
4.
Xerox
copy of Intermediate Mark Sheets
5.
Xerox
copy of Diploma Ceritficate
6.
Xerox
copy of Diploma Mark Sheets
7.
Xerox
copy of Degree (B. Sc. ) Certificate
8.
Xerox
copy of Degree (B. Sc. ) Marksheets
9.
Xerox
copy of Degree Engg. Certificate
10. Xerox copy of Degree Engg.Marksheets
11. Three Passport size Photographs
12. Bank Draft
|
Bank Draft No. |
Date of Issue |
Issuing Bank |
Amount |
|
|
|
|
|
N.
B. :
The Enclosure sheet should be with the application Form
GENERAL INSTRUCTIONS
The
candidates seeking admission to BPNSI should follow those instructions
strictly.
The
candidate should go through the prospectus carefully and acquaint with all requirements :
- He / She should satisfy the eligibility criteria as
given in the prospectus.
- The candidate should apply through Prescribed
Application Form complete in all respect or submit it online.
- Complete address with Postal Pin Code & Telephone
Number should be written in the Application Form.
- Application Form should be filled up in own
handwriting in BLOCK LETTER in English only, using blue / black ball point
pen.
- Date of Birth, candidate’s Name should be exactly
same as in 10th Pass Certificate.
- Overwriting, cutting, erasing or wrinkle on the
Application Form and incomplete Form may lead to rejection of Application
and should be avoided. Any error arising on this account shall be the
responsibility of the candidate.
- Options filled by the candidate can’t be changed at a
later stage.
- The Enclosure sheet should be with the application
Form.
- Application received after the due date will not be
considered.
- BPNSI will not be responsible for any postal delay /
irregularity / loss in postal transit of the application form.
- The Application Form duly filled in should be sent to
the Director,
- Sending
of Application Form
The
prescribed application form duly filled in should be submitted in person / by
post (Registered post / Speed Post ).
·
The following enclosures should be enclosed
with the Application form. It is not required to enclose the copy of any certificates / Marksheets . Candidates applying Online should enclose the
bank draft.
Enclosures :
1. Xerox
copy of Matric Certificate
2. Xerox
copy of Matric
Mark Sheets
3. Xerox
copy of Intermediate Certificate
4. Xerox
copy of Intermediate Mark Sheets
5. Xerox
copy of Diploma Ceritficate
6. Xerox
copy of Diploma Mark Sheets
7. Xerox
copy of Degree (B. Sc) Certificate
8. Xerox
copy of Degree (B. Sc) Mark sheets
9. Xerox
copy of Degree Engg. Certificate
10. Xerox copy of Degree Engg.
Mark sheets
11. Three Passport size Photographs
12. Bank
Draft
13.
IMPORTANT DATES :
·
Opening date of sale of Application Kit :
·
Last date of receipt of Application :
·
Start date of Admission :
·
Classes begin :
FOR DETAILS CONTACT :
BIJU PATNAIK NATIONAL STEEL INSTITUTE
Puri – 752 001, ORISSA
Fax : 06752 – 232567
e-Mail : bpnsipuri@sify.com
Web site: www.bpnsi.org