IIIT Admission Brochughjre 2014

Admission Brochure
For B.Tech. Programme 2014

V 11.1 (Final)

Important Dates
Starting Date of Online Application 20
th
May 2014
Last Date of Online Application 7
th
July 2014
Last date of receiving hard copy of the
Application
10
th
July 2014
Document verification for S & OL
category candidates
10
th
-19
th
July 2014.
Publication of provisional Allotment (1
st
round) 21
st
July 2014
.

International Institute of Information Technology Bhubaneswar
(A University Established by the Government of Odisha)
Gothapatna, PO: Malipada, Bhubaneswar - 751 003
Phones: 91.0674. 3016005/3016008, Fax- 91.674.3016009,
Web: www.iiit-bh.ac.in

Information Brochure for Admission to B.Tech. Programme - 2014
I I I T Bhubaneswar Page: 2
About the Institute:
International Institute of Information Technology, Bhubaneswar owes its origins to the
initiative of the Government of Odisha. It is a result of the desire of the Government to
establish a world class institute of Information Technology in the state. The Institute has
been converted into a unitary university by the Government of Odisha on 20th Jan 2014.
Campus:
IIIT Bhubaneswar has been operating from its permanent campus in Gothapatana in the
outskirts of Bhubaneswar since August 2009. The campus is spread over 24 acres. The
campus houses classrooms, labs, library, faculty offices. The campus i s designed to be
fully residential. There are separate residence for boys and girls. There are also
recreational facilities, sporting facilities and shopping arena for basic needs of the
students.
About the Programme:
The objective of its B.Tech programs is to prepare students for two purposes. One is to
make them successful in the Industry. The other objective is to provide knowledge and
motivation for seeking a career in research.
The curricular structure aims to achieve these goals. The curriculum blends topics from
basic sciences, humanities with technical subjects to provide the students with an inter-
disciplinary perspective. The curriculum desires to develop hard as well as soft skills
among the students so that they can be productive in a team environment.
The curriculum consists of compulsory and elective subjects, projects. The institute also
provides co-curricular training programmes for students to learn new techniques,
technologies and skills.
Placements:
While the Institute does not guarantee placements for the students, special efforts are
made to give opportunities for students to find a job in the Campus. The Institute has
been successful attracting iconic companies in IT industry and in placing deserving
students in the past. The annual compensation has ranged from 3.05 to 11.8 lakhs. It is
expected that the placements will get better in terms of compensation and quality of the
job in years to come.
Admission process:
Admission to regular B.Tech. programme will be purely based on the JEE Main rank
published by JEE 2014 i.e. total marks obtained in Paper 1 of JEE Main 2014 and score
in Class 12th or other qualifying exam (60% & 40% weightage respectively).
Admission to Lateral Entry to the B.Tech programme will be purely based on the ranks
published by OJEE 2014.
Eligibility:
The eligibility criteria for admission to regular B.Tech. programme shall be as per the
JEE Main 2014 along with the following additional requirements:
The aggregate percentage of marks in +2 Sc. should be 60% or more subject
to condition 45% or more in Physics, Mathematics & Chemistry (taken
together).
The eligibility criteria for taking admission to Lateral Entry B.Tech. programme shall be
as per the OJEE 2014 along with the following additional requirements:
The percentage in 10
th
should be 70%/7.36 CGPA or more.
The percentage in Diploma should be 75% or more.
Number of seats & reservation:
The Institute reserves 50% of the seats for Odisha Domicil e Students and the rest for
students from other states of India. In addition, there is a provision of lateral entry of
students in the second year.
The total number of seats under the Lateral Entry scheme is 10% of the sanctioned
strength in each branch along with the carry forwarded back log vacancy from the
previous year in the respective branches. Students domiciled in Odisha and possessing
Diploma in Engineering in relevant discipline are eligible to apply for Lateral Entry
Scheme.

Branch CSE EEE ETC IT
Category
S
OTH
S
OTH
S
OTH
S
OTH
Gen W Gen W Gen W Gen W
UR 14 6
30
13 6
30
14 6
30
13 6
30
SC(8%) 1 1 2 1 2 0 2 1
ST(12%) 2 1 3 1 2 1 3 1
TFW 3 Nil 3 Nil 3 Nil 3 Nil
OL(3%) 1 Nil 1 Nil 1 Nil 1 Nil
GC(5%) 1 1 1 0 1 1 1 0
PC(3%) 1 0 1 0 0 1 1 0
ES(3%) 1 0 0 1 1 0 1 0
Total 33 30 33 30 33 30 33 30

Certificates to be produced in respect of reserved
categories:
Students of Odisha Domicile (S category)
Unreserved (UR):
Candidate must be native of Odisha. To claim benefit under this category, a candidate
shall have to furnish at the time of document verification a resident/ nativity
certificate, in prescribed form (Appendix-I) from a Revenue Officer not below the rank
of Tahasildar of the area to which his/her parents belong as native. The candidate has to
submit the resident/nativity certificate in the prescribed format i.e., Appendix-I issued
not earlier than January 2014.
Scheduled Caste (SC) and Scheduled Tribes (ST):
Candidates applying for SC/ST reserved category shall furnish SC/ST certificate from
the Tahasildar of the place of birth in Odisha at the time of document verification in the
format given in this brochure (Appendix - II). The candidate has to submit the Cast
certificate in the prescribed format i.e., Appendix-II issued not earlier than January 2014.
NOTE : Scheduled Caste/Scheduled Tribe persons who have migrated from their state
of origin to another state for the purpose of seeking education, employment etc., will be
deemed to be scheduled caste/ tribe of the state of their origin and will be entitled to
derive benefits from the state of origin and not from the state to which they have
migrated. (Vide Govt. India Letter No. BC/160 14.1.82 SC & BCD/ dated 22nd Feb,
1985). Thus, SC/ST candidates from Odisha who are staying outside the State have to
produce SC/ST certificate from the competent authority of Odisha State during
document verification.
Tuition Fee Waiver (TFW):
Eligibility criteria for Tuition Fee Waiver Scheme [TFW]:
Sons and daughters of parents whose annual income is less than Rs. 4.50 lakhs
(Rupees four lakh and fifty thousand only) from all sources are eligible for seats
under this scheme. The candidates who will be interested in taking admission
under this scheme have to produce income certificate issued by local Tahasildar
(Appendix - III) during document verification.
The waiver is limited to the tuition fee only. All other fees except tuition fee will
have to be paid by the beneficiary.
The candidate should be a native of Odisha.
Candidate has to produce the following documents for claiming TFW scheme at
the institute during document verification.
o Resident/Nativity of Odisha certificate. (Appendix I). The candidate has
to submit the Residence certificate in the prescribed format i.e.,
Appendix-I issued not earlier than January 2014.
o Income certificate of parents from local Tahasildar (Appendix-III). The
candidate has to submit the Income certificate in the prescribed format
i.e., Appendix-III issued not earlier than January 2014.
Oriyas (Odias) belonging to outlying Oriya (Odia) speaking tracts (OL):
Refer to Notification NO:13411-SC-6-64/69-Gen Political & Service
Department, Govt of Odisha Dt. 8/8/1969
Due to settlement of boundaries of states some Odia speaking areas have been
merged in other neighboring states as a result of which the Odias living in these
areas who are now residents of other states have been deprived of studying Oriya
(Odia) language or Oriya (Odia) culture.
A candidate eligible to avail the reservation under OL Category must have:
1. The candidate has to submit a nativity certificate from outside the state of
Odisha in the prescribed format i.e., Appendix-IV issued not earlier than
January 2014.[Appendix IV is the Certificate of Authenticity of Oriyas
(Odias) belonging to Outlying Oriya (Odia) Speaking Tract].
2. The candidate has to pass an Odia examination with minimum 40%
marks to be conducted by the institute committee at the time of
counseling process.
3. The candidate must have passed 10+2 Science examination from outside
Odisha.
Green Card (GC):
Candidates applying under Green Card category shall furnish the Green card of their
parents issued by Family Welfare Department, Government of Odisha/any other
appropriate authority, in original at the time of document verification. The name, date
of birth of the candidate along with the parents names should match with those
mentioned in 10
th
class pass certificate. If in future it is found that the green card has
been obtained by providing wrong information or suppressing facts, the card
holder will be deprived of the facilities already obtained and will be liable for legal
punitive action.
Physically Challenged (PC):
The candidates with 40% disabilities in consonance with section-39 of the Persons with
Disabilities (Equal opportunities, Protection of Rights and Full participation) Act , 1995
are eligible to be considered under Physically Challenged Category for admission to
B.Tech. degree.The medical standard of PC category candidates will be decided by a
medical board formed by the institute. The decision of this Board will be final and
binding. They SHOULD NOT therefore, submit along with the application form any
medical certificate to the effect that they are Physically Challenged.
Ex-Servicemen (ES):
Candidates applying under Ex-Serviceman reserved category shall furnish a certificate in
the prescribed format provided in this brochure as Appendix-V at the time of document
verification.
At present 30% of the seats in all the State (S) categories are reserved for
women candidates for B. Tech programme.
Seat conversion (after counseling):
1. Any seat remaining unfilled in Other category will be transferred to Odisha State (S
Category) unreserved seat.
2. Any seat under reserved category remaining unfilled in Odisha State (S Category)will
be transferred to Odisha State (S Category) unreserved seat.
Application Procedure:
Visit the website www.iiit-bh.ac.in to apply on line for the B.Tech. Programmes. Please
note that only on-line application is accepted. The payment details has to be kept ready at
the time of filling the online application form, since the details of the payment
transaction has to be entered in the application form.
Valid email ID is mandatory for online application.
Click on the link given in the website for admission.
Enter your name and e-mail id, so that an email will be sent to your e-mail id for
enabling you to fill the form.
Click on the link given in the e-mail sent by our system.
Pay the application fee of Rs. 1000/- (Rupees one thousand only) through online
transaction.
Carefully fill in all the relevant fields of the blank application form which include
the payment details.
Submit the form by clicking the button "Submit". On successful submission, the
next screen shall display the message Data saved.
The submitted data can be modified even after pressing the Submit button but
it cannot be modified once the Commit button is pressed.
You will need the link sent to your e-mail id, as well as the e-mail id entered by
you to subsequently log in to our system and perform any or more of the
following:
Edit your application and resubmit if required.
Print your application by clicking on the print button.
The e-mail sent by our system should be carefully preserved by you. You shall
need it for subsequent steps.
Keep on visiting our Website to view important announcements regarding the
admission process.
You are required to send the following by speed post/hand delivery so as to
reach IIIT Bhubaneswar latest by 10
th
July 2014.
Printed application form (submitted on line) duly signed by the candidate
A recent color passport size photograph, pasted on the application form and
three copies of the same photograph.
Print out of the money receipt of the application fee paid.
Photocopy of the JEE(Main)/OJEE admit card.
Photocopy of the JEE(Main)/OJEE rank card.
Candidates can verify the receipt of the payment from our website by logging into their
IDs.
Counseling Procedure:
For State category, OL category and LE candidates, physical presence by the
candidate shall be necessary.
Other category candidates need not attend it in person. Detailed instructions for
counseling shall be posted on the site later.
Allotment of seats shall be done based upon the preference of choices of branches
exercised by candidates.
A State category candidate may belong to different subcategories and also eligible for
Other category. Thus, a state category candidate shall be allotted a seat considering
the best possible availability (in terms of choices exercised by the candidate) among
different categories.
Provisional admissions will be offered in order of merit list generated in different
categories to candidates.
The candidates provisionally allotted a seat are required to deposit Rs. 25,000/-
which will be adjusted along with the 1
st
semester dues.
Documents to be submitted:
For State category candidates at the time of verification
Original as well as copy of 10
th
mark sheet and pass certificate
th
Original as well as copy of JEE main 2014 rank card
Original as well as copy of JEE Main 2014 Admit card
Nativity certificate as per Appendix-I(Original)
Appendix-VI (Original)
Income certificate for TFW candidates as per Appendix-III (Original)
SC/ST certificate for SC/ST candidates as per Appendix-II (Original)
Appendix-IV (Original) for OL category candidates
Original as well as Copy of Green card of their parents issued by Family Welfare
Department, Government of Odisha/any other appropriate authority for GC
category candidates
Appendix-V (Original) for ES category candidate.
For LE Tech category candidates at the time of verification
th
Original as well as copy of Diploma mark sheet and pass certificate
Original as well as copy of OJEE 2014 rank card
Original as well as copy of OJEE 2014 Admit card
Nativity certificate as per Appendix-I(Original)
For Other category candidates at the time of reporting
th
th
Original as well as copy of JEE main 2014 rank card
Original as well as copy of JEE Main 2014 Admit card
College leaving certificate (Original)
NOTE: Original certificates/mark sheets except Appendices shall be returned to the
candidates after verification.
Fee Structure
* These fees are applicable for Hostel Boarders only
The 3
rd
semester fee for the lateral entry students is same as the 1
st
semester fee of the
regular B. Tech. students.
Aids & Scholarships:
The S category students are eligible for the following scholarships:
G B scholarship: Top three students in each branch of B.Tech. programme of each year
will be awarded this scholarship. The amounts are as follows:
First Topper : Rs 20000 per annum
Second Topper : Rs. 15000 per annum
Third Topper : Rs. 10000 per annum
o CAFAS / Medhabruti by Department of Higher Education: Rs. 10000 per
annum for four years B.Tech. program
o Prerana by SC&ST development board for Sc/ ST / OBC: Rs. 20000 to
60000 per annum.
o Scholarship by IMFA
o Scholarship by VIKAS Educational Charitable Trust: Rs. 25000 per annum
and it may increase as per student's need.
o Post Matric Scholarship by CHSE
o Scholarship from NCERT
Component 1
st
Sem 2
nd
Sem 3rd Sem 4th Sem 5th Sem 6th Sem 7th Sem 8th Sem
Tuition Fee 50000 50000 50000 50000 50000 50000 50000 50000
Library and IT
Services
5000 5000 5000 5000 5000 5000 5000 5000
Caution Deposit 13000 NA NA NA NA NA NA NA
University
Registration Fee
5000 NA NA NA NA NA NA NA
Student Welfare 1000 NA 1000 NA 1000 NA 1000 NA
Examination Fee 1500 1500 1500 1500 1500 1500 1500 1500
Hostel
Accommodation
Fee*
7500 7500 7500 7500 7500 7500 7500 7500
DG Backup & Lift
Operation Charge*
As per
Actual
As per
Actual
As per
Actual
As per
Actual
As per
Actual
As per
Actual
As per
Actual
As per
Actual
Bus Fee* 350 350 350 350 350 350 350 350
Total(Rs.) 83350 64350 65350 64350 65350 64350 65350 64350
o Special TFW scheme
Available for 3 students of the institute apart from normal TFW as per
Government norms.
Students applied for TFW scheme during admission and not allotted a seat
under that category shall be considered for this scheme subject to fulfillment
of required criteria.
Important Dates
(These date are tentative. The dates may be changed depending on date of declaration of
JEE mains Ranks):
Starting Date of Online Application: 20
th
May 2014
Last Date of Online Application: 7
th
July 2014
Last date of receiving hard copy of the Application: 10
th
July 2014
Document verification for S & OL category candidates: 10
th
-19
th
July 2014.
Publication of provisional Allotment (1
st
round): 21
st
July 2014.
Last Date of part admission fee payment for candidates provisionally allotted a seat
in the 1
st
round : 25
th
July 2014
Publication of 2
nd
round allotment: 28
th
July 2014
Last Date of part admission fee payment for new candidates provisionally allotted a
seat in the 2
nd
round : 31
st
July 2014
Publication of 3
rd
round allotment: 4
th
August 2014
Last Date of part admission fee payment for new candidates provisionally allotted a
seat in the 3
rd
round : 6
th
August 2014
Final round Admission if required: 14
th
August 2014 ( The detail procedure shall be
given in our website)
Important Notes for the Applicants Regarding Admission:
1. The choice of branches has to be filled very carefully because the allotment of branch
shall be done based upon the order of choices and rank.
2. Nativity certificate is mandatory for taking admission against any reserve category
like: Schedule Caste (SC), Schedule Tribe (ST), children/wards of Ex-Servicemen
(ES), Physically Challenged (PC), Women (WO), Green Card (GC), Tuition Fee
Waiver (TFW) in all programmes. Nativity certificate is to be produced at the time of
document verification during counseling. All such applicants are required to keep the
up-to-date nativity certificate ready well in advance before counseling. The candidate
has to submit the nativity certificate in the prescribed format i.e., Appendix-I issued
not earlier than January 2014.The nativity certificate is mandatory for admission
under Lateral Entry for the candidates who are natives of Odisha. The aforesaid
condition on nativity certificate is not applicable for candidates belonging to other
category.
3. Scheduled Castes (SC) and Scheduled Tribes (ST) students shall get a relaxation of 5
percent marks in the eligibility requirements for the seats reserved for them.
4. Mark sheet and Certificate/Provisional Certificate of the qualifying examination must
be produced on the day of document verification at the institute without which the
applicant will not be allowed to participate in the counseling/admission process.
5. Original certificates, mark sheets and other documents will be verified at the time of
document verification at the institute with respect to eligibility, category and
reservation that are claimed and shall be returned to the applicant immediately after
the verification. However, original certificates made from appendices and
photocopies of the certificates, mark sheets, and other relevant documents will be
kept during document verification at the institute. The candidate has to submit the
required certificate in the prescribed format i.e., in given in the Appendix I to VI
issued not earlier than January 2014.
6. Claim for admission will be rejected if the candidate cannot submit the original
certificates, mark sheets, other necessary documents at the time of document
verification or if one has filled the form wrongly.
7. Admission may be cancelled at any time, if certificates/ mark sheets/ other
documents are found to be forged or manipulated. A candidate will not be
considered for admission if he/she fails to substantiate the claim with respect to
reservation, category, nativity, date of birth, qualification etc.
8. Verification of documents for the candidates belonging to S & OL category is
mandatory during the document verification schedule. Those who would fail to do
the verification their candidature shall be cancelled and they shall not be considered
for seat allotment.
9. Verification of documents for the candidates belonging to OTHER category shall
be done at the time of reporting (before commencement of the 1
st
semester classes)
at the Institute.
Contact Details:
Admission Office
International Institute of Information Technology, Bhubaneswar
Gothapatna, Po. Malipada, Bhubaneswar 751003, India
Tel. : 0674-3016005/3016008, Fax : 0674 - 3016009
E-mail : btechadmission@iiit-bh.ac.in
Web Site: http://www.iiit-bh.ac.in
APPENDIX I
Office of the _ _ _ _ _ _ _ _ _ _ Miscellaneous Certificate Case No. _ _ _ _of 2014
RESIDENT/NATIVITY CERTIFICATE OF ODISHA
This is to certify that Shri/ Smt/ Miss _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
son/ daughter/wife of Shri/Smt _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ is a native
of the District of _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ in the State of Odisha and
his/her family ordinarily resides in Village/Town _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
P.S _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ , Tahasil _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
in the District of _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ .
The certificate is being granted only for the purpose of admission to IIIT Bhubaneswar
2014.

Full Signature of the Applicant Signature of Revenue Officer
Date: Date:

Round Seal of the Office Designation (with Seal of Office)

Note:
1. Revenue Officer means the Chief Officer in charge of Revenue Administrative in the
District, Sub-Division of Tahasil and includes an Additional District Magistrate and
Additional Tahasildar.
2. No part of the form should be mutilated in any manner. In case of mutilation the
certificate is liable to be rejected.
APPENDIX II
SC/ST CERTIFICATE BY BIRTH

This is to certify that Sri / Smt / Kumari _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Son/daughter of Shri/Smt _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ of
Village/Town _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ P.S_ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Tahasil _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ in the district of_ _ _ _ _ _ _ _ _ _ _ _
of the State of Odisha belongs to the ........................................... ............Caste / Tribe which
is recognized as Scheduled Caste / Tribe under Constitution (Scheduled Cast es) Order
1950 /the Constitution (Scheduled Tribes) Order, 1950 as amended by the Scheduled
Castes and Scheduled Tribes (Amendment) Orders Act 1976.
Sri / Smt / Kumari_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ and his/her family
ordinarily reside(s) in Village/Town _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _of
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ District of the State of Odisha.

Date: Date:


Note:
This certificate should be issued by Tahasildar of the place of residence of parent in
Odisha. No part of the form should be mutilated in any manner. In case of mutilation
the certificate is liable to be rejected.
APPENDIX III
INCOME CERTIFICATE
Office of the _ _ _ _ _ _ _ _ _ Miscellaneous Certificate Case No. _ _ _ _of 2014

This is to certify that, Sri / Smt / Miss _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Son / Wife / Daughter of Shri/Smt _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Village _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ P.O_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
P.S _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Tahasil _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
In the District of _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ In the state of Odisha has an
annual income Rs. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _.. (Rupees_ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _) only from the sources specified below.
SOURCE ANNUAL INCOME
in Rupees
Agriculture Land
Salaries
Business
Any other sources to be specified
Total

This Certificate is being granted only for the purpose of _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _.

Date: Date:

Note:
1. Revenue Officer means the Chief Officer in charge of Revenue Administrative in the
District, Sub-Division of Tahasil and includes an Additional District Magistrate and
Additional Tahasildar.
2. No part of the form should be mutilated in any manner. In case of mutilation the
certificate is liable to be rejected.
APPENDIX IV
CERTIFICATE OF AUTHENTICITY OF ORIYAS (ODIAS) BELONGING TO OUTLYING
ORIYA (ODIA) SPEAKING TRACT [OL CATEGORY]

This is to certify that Mr./Ms. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Son / Daughter / Spouse of Mr./Mrs . _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ of
Village / Town _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ P.S _ _ _ _ _ _ _ _ _ _ _ _ _ _
Tahasil _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ in the district of _ _ _ _ _ _ _ _ _ _ _
of the State of _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ whose full signature is given
below is an Oriya(Odia) and belongs to an outlying Oriya(Odia) speaking tract as defined
in resolution No-13411-Gen. Dated 8th August ,1969, of Government of Odisha
erstwhile political & services Department (Now: G.A Department) as specified below.

Date: Date:


APPENDIX V
Certificate of Ex-Servicemen
1. Name of the Candidate
2. Full name of employee / person
3. Permanent address as per service records
4. Rank in Defense Service
5. Full name of the Candidate
6. Relationship of the employee / person with the Candidate
7. Last place of posting including details of unit
8. Awards received if any
9. Priority

Full Signature of Candidates Parent Full Signature of Secretary Rajya Sainik Board
Date : Date

Designation (with Seal of Office)

APPENDIX VI
CERTIFICATE FROM THE HEAD OF THE INSTITUTE LAST ATTENDED

(a) Certified that _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
(Name of the candidate in full) son/daughter of_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
(Name of the father in full) born on _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ was a
bonafide student of this institute from_ _ _ _ _ _ __ _ _ _ _ _ _to_ _ _ _ _ _ _ _ _ _ _ _
and has passed_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ examination in the year
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _as per the record of the institute.
(b) Certified that the photograph pasted on the space provided below on this page is
attested by me.

The candidate should affix
the same photograph which
he/she had given during form
fill-up of JEE Main 2014
application form. The
candidate has to get this
photograph attested by the
Head of the Institution last
attended. The official seal of
the head of the institute
should cover part of this
photograph.

Full Signature of the Applicant
with Date
Signature of Head of the Institution last attended
with Date
Name:

Seal of the Institution

Designation (with Seal of Office)

Issue / reference No.................. .
N.B.: The candidate should affix the same photograph which he/she has pasted on the
application form.

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