COCHIN UNIVERSITY OF SCIENCE AND TECHNOLOGY
ONLINE APPLICATION FOR ACADEMIC ADMISSIONS -2014
REGISTRATION CONFIRMATION PAGE

14/02/2014 23:26:23

Approval of application is subject to verification of the details furnished by the candidate
Registration Number

111774

Name of candidate

JAYANT SHARMA

Name of Father

RAVIKANT SHARMA

Name of Mother

SANTOSH SHARMA

Date of Birth

10/10/1998

Age

15

Gender

MALE

Nationality

INDIAN

State

Rajasthan

Permanent Address

NEAR KANORIA HOSPITAL, WARD NO.17,
MUKUNDGARH P.O., JHUNJHUNU,
Rajasthan, Pin: 333705

Phone Number

01594252271

Mobile Number

7728081684

Valid Email Id

sharma.iitian@gmail.com

Annual Family Income

BETWEEN 42001 to 150000

Reservation Category

General

Special Reservation
Category
Qualification

Plus Two/Equivalent

Courses Applied for

B.Tech Courses/5 Yr. M.Sc Photonics

Test Centre Selected

Kota,New Delhi

Test Subjects Selected

Test for B.Tech/M.Sc Photonics

Payment Details
Name of Bank

State Bank Of India

Chalan Amount 1000 Plus Bank Charges

Journal Number

33290731

Date of
Payment

03/02/2014

Branch code

1534

Branch Name

Declaration
I have carefully read the instructions given in the website and agree to abide by the decisions of the
university regarding my selection and admission to the programme(s) that I have applied for. I declare that
all the particulars given in this online application are true to the best of my knowledge and belief.

Place:
Date:

Signature of the Candidate(Within the box)

NB: Do not send this page to the university unless demanded

Signature of Father / Mother / Guardian