7/30/2019 BE Application

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Navarathna Agrahara, Sadahalli Post, Off Bangalore International Airport Road, Bangalore - 562 110.

Tel. : +91 80 3252 9939, 3252 9575, 2846 7090 / 91, Fax : +91 80 2846 7092

Email : principal@msec.ac.in www.msec.ac.in

APPLICATION FOR ADMISSION TO B.E. COURSE

MSECM

E GS E LE LN OG CI N GEE NIR

Affix the RecentPassport Photograph

Name of the Candidate(As in the Qualifying ExaminationCertificate)

Date of Birth

E-mail ID (Student)

Mother Tongue

Religion

b) Region

Native Place

a) Permanent Address b) Local Address

Phone: Mobile :

Fathers Name

Mothers Name

Guardians Name(If Parents are not alive)

Annual Income of Parent / Guardian

E-mail : (Parent/Guardian)Name & Cell No. of a blood Relation(For Contact in Case of Emergency)

Special Category Status

KEA Admn. Order No. /Comed -K TAT No.& Date of issue

Karnataka or Non-Karnataka

Entrance RANK

Allotted Branch

M MD D Y Y Y YSex Male Female

Caste Category Nationality

Urban Rural

Village/ Town

District

Taluk

State

Phone: Mobile :

NCC Sports Scouts& Guides

Defence Physicallydisabled

Ex-Defence

Seat Type Admission Quota KEA Comed K MGT GOI FN Others(Specify)

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Occupation

Mobile :

MMDD YYYY

KEA Comed K AIEEE

Pin code : Pin code :

APPLICATION FORM No.

Branch Preferred (MGT. Quota Only)

KEA - Karnataka Examination Authority, MGT-Management Quota, FN - Foreign Nationals GOI - Government of India

An ISO 9001:2008 Certified Institution

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*

To,

The Principal

M.S. Engineering CollegeNavarathna Agrahara, Sadahalli Post,

Off Bangalore International Airport Road,

Bangalore - 562 110

Note : Please tick wherever required / Use only Block Letters / Indicate NA, if not applicable.

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7/30/2019 BE Application

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Qualifying Examination Passed

State

Name ofthe Exam

Name ofthe Board

Reg. No.

Month & Year of Passing

a) Marks obtained inOptional Subjects

1. Physics 2. MathematicsTotal Marks in

3 SubjectsPercentage

b) Marks obtained in DiplomaV/VI SemI/II Sem III/IVSem Total V/VI Sem Percentage

Miscellaneous Fee Details Receipt No. DD No. DateMMDD YYYYAmount in Rs.

Blood Group A+ A- B+ B- A+ AB+ AB- O+ O-

Any Physical Defect

Any Chronic Ailment

Sports(Specify)

Level of Participation

Cultural Activities (Specify)

National State Others (Specify)

Level of Participation National State Others (Specify)

Other Activities NCC NSSScouts & Guides Others (Specify)

Have you submitted the following Documents with 3 sets of xerox copies ?(Students admitted under Management Quota the Original Documents should be submitted as follows :

I. KEA / Comed K / AIEEE Allottment Order

ii. 12th Standard Marks Card

iii. Transfer Certificate

iv. Caste Certificate (in case of SC / ST & other Caste)

v. Eligibility Certificate from VTU in case of Non - Karnataka Students

vi. Transfer Certificate for having resided in Karnataka for a minimum period of seven years at any time.

vii. Migration Certificate in case of Non-Karnataka Students

viii. Eligibility Certificate & Other Supporting Documents for NRI Students

ix. Four passport & Stamp size photographs with name

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

No

No

No

No

No

No

No

No

I declare that I shall pay the tuition and other payable to the institution under the rules frame from time to time by the management of

the College. Under no circumstances, I will claim refund of the tuition and other fees against cancellation of admission. I undertake to pay

the prescribed fees for the entire course in case of cancellations of admission in the middle of the course

I) I Declare that the above said statement / particulars are true and correct to the best of my knowledge and belief. In case

the above said statement / particulars are found incorrect this application for the seat is liable to be rejected and forfeited.

2) I undertake that as long as I am a student of this college, I will do nothing unworthy of a student of the college

either inside or outside or any thing that will interfere with its orderly working and discipline.

3) I am aware that the management has full authority to expel me for not showing interest in studies, misbehavior

or continuous failures.

4) Original certificate should be produced for verification at any time required by the College and the University.

DECLARATION BY THE CANDIDATE

Signature of the Parent /Guardian

Place :

Bangalore :

DECLARATION BY THE PARENT GUARDIAN

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Signature of the Candidate

Place :

Bangalore :

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