Affix self attested passport size photographs
 
Form No. :

                       BIJU PATNAIK NATIONAL STEEL INSTITUTE

RAMA BALLAV ROAD, PURI

ORISSA – 752 001

 

APPLICATION FORM

 

Course Applied for :  ___________________________________________________

 

 

FOR OFFICE USE ONLY

SELECTED : YES            NO                      JOINED : YES               NO

 

Date of Joining :                                     ROLL NUMBER 

 

 
 

 
 

 
 

 
 
 

 

 

 

 
 
 

 

 

 

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 : _____ Years _______ Months

                                                                                             

8. Sex : Male                    Female                                     9. Nationality : _______________________

 
 

 
 

 
 

 
 
10. Category :  SC                        ST                              OBC                         GENERAL

     (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 (In prescribed format) :

       (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 

13.  Experience Certificate (In prescribed format)

 

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 :

  1. He / She should satisfy the eligibility criteria as given in the prospectus.
  2. The candidate should apply through Prescribed Application Form complete in all respect  or submit it online.
  3. Complete address with Postal Pin Code & Telephone Number should be written in the Application Form.
  4. Application Form should be filled up in own handwriting in BLOCK LETTER in English only, using blue / black ball point pen.
  5. Date of Birth, candidate’s Name should be exactly same as in 10th Pass Certificate.
  6. 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.
  7. Options filled by the candidate can’t be changed at a later stage.
  8. The Enclosure sheet should be with the application Form.
  9. Application received after the due date will not be considered.
  10. BPNSI will not be responsible for any postal delay / irregularity / loss in postal transit of the application form.
  11. The Application Form duly filled in should be sent to the  Director, Biju Patnaik National Steel Institute, Rama Ballav Road, Puri – 752 001, Orissa”.
  12. 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.  Experience Certificate (In prescribed format)

 

FOR DETAILS CONTACT :

BIJU PATNAIK NATIONAL STEEL INSTITUTE

Rama Ballav Road,

Puri – 752 001, ORISSA

Ph : 06752 –232880, 232820

e-Mail : bpnsipuri@sify.com

Web site: www.bpnsi.org