ANNEXURE IV: APPLICATION FORM (B) FOR ADMISSION TO PROFESSIONAL DEGREE COURSES 2016-17 (EXCEPT B.ARCH.) FORM B REGN. No. INSTRUCTIONS TO CANDIDATES: GCET NO. 1. Read rules of admission and eligibility criterion as given in the prospectus before filling the form. 2. Applicant must fill the form in his/her own handwriting, after downloading & printing the same from the website, or obtaining it from the Application Receiving Centre, and submit the same at the Application Receiving Centres on specified dates along with self attested copies of required documents. 3. Applicants who have not submitted Form A earlier, need to remit an application fee of Rs. 1500/-, payable vide Demand Draft, at Panaji, drawn on any Scheduled bank, in the name of Director of Technical Education, or any other approved mode of remittance, as may be duly notified. Affix photograph 1. CATEGORY APPLIED FOR (Tick the appropriate box(es)) 1 2 3 4 5 6 7 8 9 10 11 12 13 GN NRI* GEN SC ST OBC PH FF CSP ESM LA OGA KM ST OBC GO NGO *NRI Category applicants may indicate if they are of Goan Origin(GO),Not Goan Origin(NGO) 2. NAME OF THE CANDIDATE (In Block letters as recorded in the HSSC/SSC mark sheet) 3. GENDER: Male Female (Tick the appropriate box) 4. CONTACT NO. 5. DATE OF BIRTH 6. H.S.S.C. (Std. XII Sc.) or Equivalent Examination: (Details & Marks) Board: Month: Year: Seat No.: ENGLISH PHYSICS CHEMISTRY MATHS BIOLOGY OTHERS AGGREGATE MAX MARKS MAX MARKS MAX MARKS MAX MARKS MAX MARKS MAX MARKS MAX MARKS 7. GCET- 2016 MARKS GCET-2016 ROLL NO.: PHYSICS CHEMISTRY MATHEMATICS BIOLOGY 8. CHECK LIST FOR THE DOCUMENTS TO BE ATTACHED 1. Please attach self- attested xerox copies of the certificates in following order and tick appropriately. 2. No original document should be attached, as the admission committee shall not be responsible for loss of original document ESSENTIAL DOCUMENTS Sr. No. Document Attached Checked 1. Photograph on the form 2. Statement of marks/certificate/provisional certificate of passing HSSC 3. Certificate of residence 4. Documents for relaxation in the period of residence, if any 5. Certificate for reserved category claimed 6. Certificate of date of birth 7. School/college leaving certificate 8. Eligibility Certificate from Goa University (for applicants other than Goa Board) 9. Income Certificate (For Tuition Fee Waiver) 10. Candidate Copy of GCET Admit Card 11. Acknowledgement card with photograph
9. DECLARATION OF APPLICANT Certified that I, am an Indian National/OCI, and have read and accepted the provisions of the Prospectus, and have enclosed the self-attested copies of all the certificates in proper order as required, and submitted the application complete in all respects. In the event of my application found to be deficient or incomplete, and rejected by Admitting Authority, I shall be held responsible for the same. I, hereby declare that the particulars furnished above are true, complete, and correct to the best of my knowledge and belief. I am fully aware that in the event of any information being found false or incorrect, or ineligible, being detected before or after the admission, appropriate action as deemed fit, by the Competent Authority, can be taken against me. PLACE: DATE: (Signature of the Applicant) ADDRESS : PHONE/MOBILE: 10. DECLARATION BY PARENT/GUARDIAN OF THE APPLICANT I, Shri/Smt. aged years, father/mother/guardian of Mr./Miss., resident of Village/Town, District, in the State of hereby declare that I have read and accepted the provisions of the Prospectus and the Particulars furnished in the application, including total annual income of both parents, are correct to the best of my knowledge and belief. I declare that I shall be held responsible for timely payment of all fees, rent, and other charges in respect of my son/daughter/ward during the period of his/her studies in the College. I hereby declare that the Institute will not in any way be held responsible for accidents/injuries caused to my ward during the Classes, Practicals, Inplant Training in Industries, Educational Tours, Sports activity etc. DATE: (Signature of the Parent/Guardian)
ANNEXURE V: APPLICATION FORM(B1) FOR ADMISSION TO B.ARCH DEGREE COURSE 2016-17. FORM B1 NATA REGN. No. INSTRUCTIONS TO CANDIDATES: GCET NO. 1. Read rules of admission and eligibility criterion as given in the prospectus before filling the form. 2. Applicant must fill the form in his/her own handwriting, after downloading & printing the same from the website, or obtaining it from the Application Receiving Centre, and submit the same at the Application Receiving Centres on specified dates along with self attested copies of required documents. 3. Applicants who have not submitted Form A earlier, need to remit an application fee of Rs. 1500/-, payable vide Demand Draft, at Panaji, drawn on any Scheduled bank, in the name of Director of Technical Education, or any other approved mode of remittance, as may be duly notified. Affix photograph 1. CATEGORY APPLIED FOR (Tick the appropriate box (es)) 1 2 3 4 5 6 7 8 9 10 11 GEN SC ST OBC PH FF CSP ESM LA GN OGA ST OBC 2. NAME OF THE CANDIDATE (In Block letters as recorded in the HSSC/SSC mark sheet) 3. GENDER: Male Female (Tick the appropriate box) 4. CONTACT NO. 6. H.S.S.C. (Std. XII Sc.) or Equivalent Examination: (Details & Marks) 5. DATE OF BIRTH - - Board: Month: Year: Seat No.: ENGLISH PHYSICS CHEMISTRY MATHS BIOLOGY OTHERS AGGREGATE MAX MARKS MAX MARKS MAX MARKS MAX MARKS MAX MARKS MAX MARKS MAX MARKS 7. NATA Scores TOTAL MARKS AT Std. XII TH /DIPLOMA NATA SCORE (FOR B. ARCH APPLICANTS) 8. CHECK LIST FOR THE DOCUMENTS TO BE ATTACHED 1. Please attach self- attested xerox copies of the certificates in following order and tick appropriately. 2. No original document should be attached, as the admission committee shall not be responsible for loss of original document ESSENTIAL DOCUMENTS Sr. No. Document Attached Checked 1. Photograph on the form 2. Statement of marks/certificate/provisional certificate of passing HSSC 3. Certificate of residence 4. Documents for relaxation in the period of residence, if any 5. Certificate for reserved category claimed 6. Certificate of date of birth 7. School/college leaving certificate 8. Eligibility Certificate from Goa University (for applicants other than Goa Board) 9. Income Certificate (For fee concession) 10. Candidate Copy of GCET Admit Card 11. Acknowledgement card with photograph 12. NATA Score card
9. DECLARATION OF APPLICANT Certified that I, am an Indian National/OCI, and have read and accepted the provisions of the Prospectus, and have enclosed the self-attested copies of all the certificates in proper order as required, and submitted the application complete in all respects. In the event of my application found to be deficient or incomplete, and rejected by Admitting Authority, I shall be held responsible for the same. I, hereby declare that the particulars furnished above are true, complete, and correct to the best of my knowledge and belief. I am fully aware that in the event of any information being found false or incorrect, or ineligible, being detected before or after the admission, appropriate action as deemed fit, by the Competent Authority, can be taken against me. PLACE: DATE: (Signature of the Applicant) ADDRESS : PHONE/MOBILE: 10. DECLARATION BY PARENT/GUARDIAN OF THE APPLICANT I, Shri/Smt. aged years, father/mother/guardian of Mr./Miss., resident of Village/Town, District, in the State of hereby declare that I have read and accepted the provisions of the Prospectus and the Particulars furnished in the application, including total annual income of both parents, are correct to the best of my knowledge and belief. I declare that I shall be held responsible for timely payment of all fees, rent, and other charges in respect of my son/daughter/ward during the period of his/her studies in the College. I hereby declare that the Institute will not in any way be held responsible for accidents/injuries caused to my ward during the Classes, Practicals, Inplant Training in Industries, Educational Tours, Sports activity etc. DATE: (Signature of the Parent/Guardian)
GOVERNMENT OF GOA DIRECTORATE OF TECHNICAL EDUCATION DEGREE COURSES ADMISSION COMMITTEE- 2016 ACKNOWLEDGEMENT CUM ADMISSION CARD Photograph Registration No. Name Categories Eligibility MBBS/BDS/BHMS/BAMS B.E B.Pharm. B.Arch AHS/NURSING Order of Merit Concession Nil 30% 50% DETAILS OF ADMISSION (ADMISSION CARD) Admission Round Date Course Institute Sign. of Authority FIRST Acknowledgement of Institute. SECOND EXTRA (if applicable) 1. Acknowledgement Card along with the Registration No. is the proof of acceptance of the Application Form (B) by the Admission Committee. 2. Acknowledgement Card shall not be issued unless the form is complete in all respects. 3. Acknowledgement Card shall therefore be the identity of the applicant for any inquiry, complaint, or correspondence with the Admission Committee. 4. Admission card, to be submitted to the institute to register the admission with the institute, shall be given at the time of admission. 5. Admission card shall not be handed over to the applicant in case the original documents are not submitted or the total fees payable are not paid at the time of admission. 6. Applicants granted admission during any round shall report to the respective institution within 3 working days of grant of admission, and obtain acknowledgement thereof, failing which their admission is liable to be cancelled, and/or they may not be permitted to attend further admission rounds. DIRECTORATE OF TECHNICAL EDUCATION, ALTO - PORVORIM GOA 403521
ANNEXURE V: APPLICATION FORM FOR GCET 2016 FORM (A) Roll No. (Not to be filled by candidate) INSTRUCTIONS: i) Candidates are advised to read instructions overleaf carefully before filling the form. ii) Applicant must fill the form in his/her own handwriting, after downloading & printing the FORM A from the website, on good quality A4 Size bond paper and submit the same at the notified locations (as per Centre opted), on specified dates, along with self attested copies of required documents. NAME: (In CAPITAL LETTERS as it appears in SSCE certificate) Recent Photograph (Paste Here) DATE OF BIRTH: (as in SSCE certificate) - - PLACE OF BIRTH: GENDER: Male Female (Tick the appropriate box) ADDRESS: House No. Street Name/Area Village/Town/City Pin Code State PHONE NO MOBILE ACADEMIC DETAILS: Exam Board Exam (Month/Year) Exam Seat No. XII Science GCET Subjects and Centre: Encircle appropriate boxes for the subjects opted, crossing out subjects not opted (X) GCET SUBJECT CODE PY CH MA BY GCET CENTRE CODE Centre name: - Payment Details: DD No. Bank Name: Dated: DECLARATION I, state that I have read and accepted the provisions of the Prospectus and GCET Rules, and have enclosed the self-attested copies of all the certificates required and submitted the application complete in all respects. In the event of my application found to be incomplete and hence rejected by the admitting authority, I shall be held responsible for the same. I, hereby declare that the particulars furnished above are true, complete and correct to the best of my knowledge and belief. I am fully aware that in the event of any information being false or incorrect and detected before or after the admission, appropriate action as deemed fit by the Competent Authority can be taken against me. PLACE: DATE: (Signature of the Applicant) (Name of Applicant) (Signature of Parent/Guardian) (Name of Parent/Guardian) DIRECTORATE OF TECHNICAL EDUCATION, ALTO - PORVORIM GOA 403521