Instruction for Candidate:- 1. 2. Thi s sheet ( Sheet - 1) to be re tai ned by you carefully. 3. Your Login i d is 4. Remembe r your pass wor d an d do not disclose to anyone. 5. Sheet - 2 is th e Applicati on For m to be se nt by Regis ter ed / Speed Post on ly to a. Sti ck your c olor photo i n de signat ed plac e. b. Put you r si gnature a t desi gnate d pl ace. c. Reques t you r Par ent / Guard ian t o sig n at de signat ed pl ace. 6. Sheet - 3 is Appl ication Form t o be ret ained by yo u for yo ur ref erence. MVPH3103 There are 5 sheets in this file. IIT MADRAS ZONE 7. Sheet - 5 has t hree c opi es of bank ch all an. Ta ke it to b ank and pay t he fee s. Bank will retain a copy with them and will return two copies to you. In those two copies, retain the STUDENT copy with you and attach the IIT copy with application form. 8. Attach attest ed copie s of SSLC certi ficate w here your date of birth is mentioned clearly, and all other applicable certificates (SC/ST/PD/DS/Enlarged Font request). 9. Insert completed Application Form with enclosures (if any) into A4 size cover, withou t fold ing. 10. 11. Stick the Shee t-4 on to p the A4 size co ver and p ost it. Sheet - 4 contain the address of the IIT MADRAS ZONE to which the application form needs to be posted. Sheet - 1
2. This sheet (Sheet - 1) to be retained by you carefully.
3. Your Login id is
4. Remember your password and do not disclose to anyone.5. Sheet - 2 is the Application Form to be sent by Registered / Speed Post only to
a. Stick your color photo in designated place.
b. Put your signature at designated place.
c. Request your Parent / Guardian to sign at designated place.
6. Sheet - 3 is Application Form to be retained by you for your reference.
MVPH3103
There are 5 sheets in this file.
IIT MADRAS ZONE
7. Sheet - 5 has three copies of bank challan. Take it to bank and pay the fees.Bank will retain a copy with them and will return two copies to you. In those two copies, retain the STUDENT copywith you and attach the IIT copy with application form.
8. Attach attested copies of SSLC certificate where your date of birth is mentioned clearly, and all other applicablecertificates (SC/ST/PD/DS/Enlarged Font request).
9. Insert completed Application Form with enclosures (if any) into A4 size cover, without folding.
10.
11. Stick the Sheet-4 on top the A4 size cover and post it.
Sheet - 4 contain the address of the IIT MADRAS ZONE
APPLICATION FORM FOR JOINT ENTRANCE EXAMINATION - 2010
Application No: Zone:A361021350 IIT MADRAS ZONE
Name of the Candidate as inthe 10th Class Certificate
Name of the one Parent / Guardianas in 10th Class Certificate
Relationship of Person atS.No.2 with the Candidate
CategorySub Category
Gender
Nationality
Date of Birth (DD/MM/YYYY)
Year of passing 10th Classor Equivalent
Year of Passing 10+2Class or Equivalent
Question Paper Language
This Attempt at JEE
Type of Preparation
Counselling
Place of 10th Schooling
Mother Tongue
Parent's / Guardian's
Educational Background
Parent's / Guardian's TotalAnnual Income
Fee Amount
Choice of ExaminationCenter
Pincode or PermanentPlace of Residence
Parent's / Guardian'sOccupation
1.
2.
3.
4.5.
6.
7.
8.
9.
10.
14.
19.
20.
21.
22.
23.
24.
25.
26.
27.
12.
13. 602 - Hyderabad606 - Warangal
FATHER
GENone
FEMALE
INDIAN
31/03/1993
2008
Appearing in 2010
ENGLISH
FIRST
SELF STUDY
IIT MADRAS COUNSELLING
CITY
Telugu
BOTH PARENTS GRADUATE
Law Practice
Rs.3,00,000 - 6,00,000
500007
I hereby declare that all the particulars stated in this application form are true to the best of my knowledge and belief. I have read theInformation Brochure and I shall abide by the terms and conditions therein. I also certify that I have not appreared in JEE in 2008 or earlierand have not accepted admission by paying full fees at any of the IITs, IT-BHU or ISM. In the event of suppression or distortion of any fact
regarding the eligibility criteria nationality etc in my application form I understand that I will be denied the opportunity to appear in JEE
Rs. 450
IIT COPY
Year of First Attempt
If Appeared more than once,Year of passing with min Marks
APPLICATION FORM FOR JOINT ENTRANCE EXAMINATION - 2010
Application No: Zone:A361021350 IIT MADRAS ZONE
Name of the Candidate as inthe 10th Class Certificate
Name of the one Parent / Guardianas in 10th Class Certificate
Relationship of Person atS.No.2 with the Candidate
CategorySub Category
Gender
Nationality
Date of Birth (DD/MM/YYYY)
Year of passing 10th Classor Equivalent
Year of Passing 10+2Class or Equivalent
Question Paper Language
This Attempt at JEE
Type of Preparation
Counselling
Place of 10th Schooling
Mother Tongue
Parent's / Guardian's
Educational Background
Parent's / Guardian's TotalAnnual Income
Fee Amount
Choice of ExaminationCenter
Pincode or PermanentPlace of Residence
Parent's / Guardian'sOccupation
1.
2.
3.
4.5.
6.
7.
8.
9.
10.
14.
19.
20.
21.
22.
23.
24.
25.
26.
27.
12.
13. 602 - Hyderabad606 - Warangal
FATHER
GENone
FEMALE
INDIAN
31/03/1993
2008
Appearing in 2010
ENGLISH
FIRST
SELF STUDY
IIT MADRAS COUNSELLING
CITY
Telugu
BOTH PARENTS GRADUATE
Law Practice
Rs.3,00,000 - 6,00,000
500007
I hereby declare that all the particulars stated in this application form are true to the best of my knowledge and belief. I have read theInformation Brochure and I shall abide by the terms and conditions therein. I also certify that I have not appreared in JEE in 2008 or earlierand have not accepted admission by paying full fees at any of the IITs, IT-BHU or ISM. In the event of suppression or distortion of any fact
regarding the eligibility criteria nationality etc in my application form I understand that I will be denied the opportunity to appear in JEE
Rs. 450
STUDENT COPY
Year of First Attempt
If Appeared more than once,Year of passing with min Marks
