National Institute of Electronics and Information Technology
Ministry of Electronics and Information Technology, Government of India
A LEVEL ONLINE PROJECT FORM
Application Number Application Date & Time For Office Use Only
Demand Note No. 8299652
PAIT0522000340 28-Nov-2022 08:00:53 PM Demand Note Date 28-Nov-2022
Batch No.
1. Applicant's Personal Details / आवेदक का व्यक्तिगत विवरण
Applicant's Full Name / आवेदक का पूरा नाम Mr.Shailendra
Father's/Guardian's Name / पिता/अभिभावक का नाम Mr. Shivnandan
Mother's Name / माता का नाम Mrs. Sharmila
Date of Birth / जन्म दिनांक (dd/mm/yyyy) 06-Jun-1995
2. Registration Details / पंजीयन का विवरण
Registration No. / पंजीकरण संख्या 1273728
Course Name / कोर्स का नाम A LEVEL
Candidate Type / उम्मीदवार का प्रकार Direct Candidate
3. Contact Details / संपर्क
विवरण
Phone with STD code / दूरभाष एस टी डी कोड सहित
Mobile Number / मोबाइल नंबर 9792556552
Email Address / ईमेल पता
[email protected]4. Correspondence Address / पत्राचार का पता
Address / पता VILL RUDAMAU, POST MADHOGANJ, POLICE STATION MADHOGANJ
HARDOI
District:- Hardoi,
State:- Uttar Pradesh, Pin:- 241302
5. Project Details / प्रोजैक्ट का विवरण
Project Appearing / प्रोजैक्ट देने 01. PJ1 Major Project
5. Fee Details / शुल्क विवरण
No. of Modules & Fee/Module / मॉड्यूल की संख्या & शुल्क/मॉड्यूल 1 1000.00
Form Processing Fees / फार्म का प्रसंस्करण शुल्क 0.00 (Not Applicable)
Late Fees(if applicable) / विलंब शुल्क (यदि लागू हो) 0.00 (Not Applicable)
Total Fees / कु ल शुल्क One Thousand Rupees Only 1000.00
8. Payment Detail
Applying This Exam As Direct Candidate
Application Examination Fee will be Deposited by
Payment Mode: ONLINE
Transaction no. of payment receipt भुगतान रसीद की ट्रांजेक्शन संख्या YHD41589287448 Transaction Date 30-Nov-2022 11:02
Note * : Please don't send this form without making payment./कृ पया इस फार्म को भुगतान के बिना नहीं भेजें
Note *: Please pay project fee through available payment options and after making payment submit project along with this form and payment receipt for institute verification to the
institute mentioned above in the form. /कृ पया भुगतान के लिए उपलब्ध विकल्पों में से किसी एक का चयन करके प्रोजैक्ट शुल्क का भुगतान कर ऊपर वर्णित संस्थान को सत्यापन के लिए प्रोजैक्ट के साथ फार्म
एवं भुगतान रसीद प्रस्तुत करें |
Note *: Last date of payment of project fee / प्रोजैक्ट शुल्क का भुगतान की अंतिम तारीख: 13-Dec-2022
7. Declaration / घोषणा
I Shailendra S/oShivnandan registered hereby declare that, all the particular stated in the application, are true to the best of my knowledge and belief. I hereby certify that I have applied
the aforesaid checks before submitting the Online Project Form. I have read and understood all the instructions available on the site. I agree to abide by the rules and regulations of the
NIELIT and also to the decision of the Examination Authority, on any issue related to my Project. I have noted that the Examination Authority has the right to withhold my result ever
after appearing in the Project in addition to any other action as may be deemed fit in the event of any of the statements made above being found incorrect or my candidature being
found ineligible at a later date. I have specially gone through the eligibility criteria laid down by NIELIT for appearing in different projects and I confirm that I fullfill the eligibility for the
Project modules, I have applied for.
Left hand thumb impression / बाएं हाथ के अंगूठे का निशान Signature of Applicant/ हस्ताक्षर
