FORM NO: NITJSR/ACD-ADM/001

jk"Vªh; ÁkS|ksfxdh laLFkku te'ksniqj

NATIONAL INSTITUTE OF TECHNOLOGY JAMSHEDPUR
Jamshedpur – 831014, Jharkhand, India
(An Institution of National Importance under MHRD, Govt. of India)

Academic Session 2022-23

Paste
passport size ADMISSION FORM for M.Tech. Programmes (Fill with capital letters only)
photograph
4 cm x 4 cm ID No: 2 0 2 2 P G
(Office Use Only)

1. Name of the Student:

(in Hindi) as per high school certificate

First name Middle name

2. Name of the Student:
(in English) as per high school certificate Last name

Mobile:

Email: Aadhaar No.

3. Sex: M/F 4. Category: GE/OBC/SC/ST PD: Y/N
5. State of domicile:
6. Nationality:
7. Religion:
8. Minority Community (if applicable):
D D M M Y Y Y Y
9. Date of Birth:

10. Blood Group: [A, AB, B, O] RH +/-

11.(a) GATE/CCMT REG. No:
(b) GATE AIR: (c) AIR (Category):
12. Father’s name:
Occupation:
Email:
Mobile:

13. Mother’s name:

Occupation:

Email:

Mobile:
14. Guardian’s Name:
(if parent is not guardian)
Occupation:

Email:
Mobile:
1
15. Parents/Guardian’s Address:
a) Permanent: ________________________________ b) Office: __________________________________
_________________________________________ _______________________________________
_________________________________________ _______________________________________
Mobile No. __________________________________ Mobile No. ________________________________
Tel. with STD/ISD code ________________________ Tel. with STD/ISD code ______________________
Email: ______________________________________ Email: ____________________________________

c) Residential / Correspondence address: ______________________________________________________

________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Mobile No._____________________________ Tel. with ISD/STD code ______________________________

16. Declaration by parents regarding local guardian (for non-Jamshedpur based students):
We nominate Shri/Smt. ____________________________________ Relation ______________________
as the local guardian for my ward. The address of the local guardian is:

Address: __________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Mobile No ______________ Tel. No.____________ E-mail:____________________________________

Please mail all performance reports and other correspondence to the address mentioned at S. No.
15(a) / 15(b) / 15(c) / 16 (Please tick any one).

(Signature of Mother / Father / Guardian)

17. Are you under any regular treatment Yes No
If yes, mention prescribed medicines ____________________________________________________
____________________________________________________

18. Nearest Railway Station (to the current residential address)

Nearest Airport (to the current residential address)

19. Gross Family Annual Income (in Rs.)

20. Bank Account No.

State Bank of India,
NIT Jamshedpur
IFSC Code: SBIN0001882
* SBI NIT Jamshedpur Account is Mandatory.
21.History of Hospitalization _______________________________________________________________

2
22. Emergency Contact Person: (please tick one of the three below)
Parents as in Sl. No.17 Local Guardian as Sl. No.18

Others: Give detail: Name : _____________________________________________________

Address : _____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
Telephone No : ____________________Mobile No. ______________________
E-mail : _____________________________________________________

23. Academic qualifications

Name of Institution
/Board / University from Examination Year of Marks
Division Maximum Marks
where Certificate / Passed Passing obtained
Degree obtained

24. Document to be submitted at the time of admission:

Sl.
Details of Documents (Xerox Copies / Original) Verified Remarks if any
No.
01. Provisional Admission Letter (Original) YES / NO
02. Score Card issued by GATE YES / NO
03. High School (Class – X) Certificate as proof of age YES / NO
04 Class – XII / Intermediate Mark Card and Passing Certificate YES / NO
05. Proof of Passing qualifying examination YES / NO
06. Marks Cards of the qualifying examination YES / NO
School / College Leaving Certificate (Original)
07. YES / NO
(Certificate from the Institution last attended)
08. Migration Certificate (Original) YES / NO
Character Certificate from the Institution last attended
09. YES / NO
(Original)
Category Certificate in case of SC / ST / OBC-NCL / EWS
10. candidate issued by the competent authority (OBC-NCL/ EWS YES / NO
certificate should be issued on or after 01.04.2022)
Certificate for Physically Challenged (if applicable) issued by
11. YES / NO
the competent authority
12. O.B.C. undertaking YES / NO
13 Copy of Aadhaar Card YES / NO
14 Medical Fitness Certificate (as per CCMT/ CCMN) YES / NO
25. Details of Payment:
Sl.No Transaction ID No. Amount Date Name of the Bank

3
26. Submitted following documents:
• Medical Examination Report Yes No
• Demand Draft Yes No
• Undertakings:
a) Awareness of medical facilities at NIT Jamshedpur Dispensary Yes No
b) Not owning/ or using motor driven vehicles in the NIT Campus Yes No
c) Not going towards Kharkhai river area / Villages / Basti Yes No
d) Anti-ragging verdict by the Hon’ble Supreme Court and indecent behavior towards junior / fellow
student. Yes No
e) Late submission of qualifying degree certificate Yes No
27. Declaration by the Student:

• I do hereby agree to abide by all the Ordinances/Statutes and Regulations of the Institute in force
from time to time.
• I do hereby certify that entries made by me in this form are correct to the best of my knowledge.
• I do hereby solemnly declare that I have not been debarred at any time from joining any educational
Institution or rusticated from the Institution/University last attended.
• I declare that I have not been associated (actively or passively) with any unlawful organization in the
past nor I would associate myself with such organizations in future.
• I hereby solemnly declare that I will maintain good conduct throughout my stay at this Institute.
• I understand that the Institute reserves the right to cancel my admission at any time during my stay
at the Institute, if the Institute is satisfied that it was in the interest of the Institute to do so.

Date: __________________________ __________________________

Full Signature of the Student

28. Parent’s/Guardian’s Declaration:

• I undertake to pay all Institute fees and subsidiary dues in respect of my ward/son /daughter Sri/Ms.
_____________________________________________who is being admitted to the National
Institute of Technology, Jamshedpur.
• I hereby assure that my ward /son / daughter will abide by all Ordinances/Statutes and Regulations
of the Institute.
• I hereby certify that the entries made by my ward in this form are correct to the best of my
knowledge and belief.

Place ___________________ ______________________________________

Date: ___________________ Signature of the Parent / Guardian
Full Name _____________________________
Note:
1. In case of any change in address and/or telephone numbers, parents are requested to kindly intimate the same in writing or by e-mail to the
Dean (Academic) email: dean.ac@nitjsr.ac.in.
2. The spelling of the name written (in Hindi and English) above will appear in your degree certificate, therefore, you are requested to write
your name correctly without any mistake as per high school certificate.

FOR OFFICE USE ONLY

ID No: 2 0 2 2 P G

Discipline:

_______________________________ _______________________________
Signature of Verifying Officer Signature of Dy. Registrar (Academic)
Full Name:
___________________________
Signature of Dean (Academic)

4
 FORM NO: NITJSR/ACD-ADM/001

jk"Vªh; ÁkS|ksfxdh laLFkku te'ksniqj

NATIONAL INSTITUTE OF TECHNOLOGY JAMSHEDPUR
Jamshedpur – 831014, Jharkhand, India
(An Institution of National Importance under MHRD, Govt. of India)

Academic Session 2022-23

Paste
passport size ADMISSION FORM for M.Sc. Programmes (Fill with capital letters only)
photograph
4 cm x 4 cm ID No: 2 0 2 2 P G
(Office Use Only)

1. Name of the Student:

(in Hindi) as per high school certificate

First name Middle name

2. Name of the Student:
(in English) as per high school certificate Last name

Mobile:

Email: Aadhaar No.

3. Sex: M/F 4. Category: GE/OBC/SC/ST PD: Y/N
5. State of domicile:
6. Nationality:
7. Religion:
8. Minority Community (if applicable):
D D M M Y Y Y Y
9. Date of Birth:

10. Blood Group: [A, AB, B, O] RH +/-

11.(a) JAM REG. No:
(b) JAM AIR: (c) AIR (Category):
12. Father’s name:
Occupation:
Email:
Mobile:

13. Mother’s name:

Occupation:

Email:

Mobile:
14. Guardian’s Name:
(if parent is not guardian)
Occupation:

Email:
Mobile:
1
15. Parents/Guardian’s Address:
a) Permanent: ________________________________ b) Office: __________________________________
_________________________________________ _______________________________________
_________________________________________ _______________________________________
Mobile No. __________________________________ Mobile No. ________________________________
Tel. with STD/ISD code ________________________ Tel. with STD/ISD code ______________________
Email: ______________________________________ Email: ____________________________________

c) Residential / Correspondence address: ______________________________________________________

________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Mobile No._____________________________ Tel. with ISD/STD code ______________________________

16. Declaration by parents regarding local guardian (for non-Jamshedpur based students):
We nominate Shri/Smt. ____________________________________ Relation ______________________
as the local guardian for my ward. The address of the local guardian is:

Address: __________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Mobile No ______________ Tel. No.____________ E-mail:____________________________________

Please mail all performance reports and other correspondence to the address mentioned at S. No.
15(a) / 15(b) / 15(c) / 16 (Please tick any one).

(Signature of Mother / Father / Guardian)

17. Are you under any regular treatment Yes No
If yes, mention prescribed medicines ____________________________________________________
____________________________________________________

18. Nearest Railway Station (to the current residential address)

Nearest Airport (to the current residential address)

19. Gross Family Annual Income (in Rs.)

20. Bank Account No.

State Bank of India,
NIT Jamshedpur
IFSC Code: SBIN0001882
* SBI NIT Jamshedpur Account is Mandatory.
21.History of Hospitalization _______________________________________________________________

2
22. Emergency Contact Person: (please tick one of the three below)
Parents as in Sl. No.17 Local Guardian as Sl. No.18

Others: Give detail: Name : _____________________________________________________

Address : _____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
Telephone No : ____________________Mobile No. ______________________
E-mail : _____________________________________________________

23. Academic qualifications

Name of Institution
/Board / University from Examination Year of Marks
Division Maximum Marks
where Certificate / Passed Passing obtained
Degree obtained

24. Document to be submitted at the time of admission:

Sl.
Details of Documents (Xerox Copies / Original) Verified Remarks if any
No.
01. Provisional Admission Letter (Original) YES / NO
02. Score Card issued by JAM YES / NO
03. High School (Class – X) Certificate as proof of age YES / NO
04 Class – XII / Intermediate Mark Card and Passing Certificate YES / NO
05. Proof of Passing qualifying examination YES / NO
06. Marks Cards of the qualifying examination YES / NO
School / College Leaving Certificate (Original)
07. YES / NO
(Certificate from the Institution last attended)
08. Migration Certificate (Original) YES / NO
Character Certificate from the Institution last attended
09. YES / NO
(Original)
Category Certificate in case of SC / ST / OBC-NCL / EWS
10. candidate issued by the competent authority (OBC-NCL/ EWS YES / NO
certificate should be issued on or after 01.04.2022)
Certificate for Physically Challenged (if applicable) issued by
11. YES / NO
the competent authority
12. O.B.C. undertaking YES / NO
13 Copy of Aadhaar Card YES / NO
14 Medical Fitness Certificate( as per CCMT/ CCMN) YES / NO
25. Details of Payment:
Sl.No Transaction ID No. Amount Date Name of the Bank

3
26. Submitted following documents:
• Medical Examination Report Yes No
• Demand Draft Yes No
• Undertakings:
a) Awareness of medical facilities at NIT Jamshedpur Dispensary Yes No
b) Not owning/ or using motor driven vehicles in the NIT Campus Yes No
c) Not going towards Kharkhai river area / Villages / Basti Yes No
d) Anti-ragging verdict by the Hon’ble Supreme Court and indecent behavior towards junior / fellow
student. Yes No
e) Late submission of qualifying degree certificate Yes No
27. Declaration by the Student:

• I do hereby agree to abide by all the Ordinances/Statutes and Regulations of the Institute in force
from time to time.
• I do hereby certify that entries made by me in this form are correct to the best of my knowledge.
• I do hereby solemnly declare that I have not been debarred at any time from joining any educational
Institution or rusticated from the Institution/University last attended.
• I declare that I have not been associated (actively or passively) with any unlawful organization in the
past nor I would associate myself with such organizations in future.
• I hereby solemnly declare that I will maintain good conduct throughout my stay at this Institute.
• I understand that the Institute reserves the right to cancel my admission at any time during my stay
at the Institute, if the Institute is satisfied that it was in the interest of the Institute to do so.

Date: __________________________ __________________________

Full Signature of the Student

28. Parent’s/Guardian’s Declaration:

• I undertake to pay all Institute fees and subsidiary dues in respect of my ward/son /daughter Sri/Ms.
_____________________________________________who is being admitted to the National
Institute of Technology, Jamshedpur.
• I hereby assure that my ward /son / daughter will abide by all Ordinances/Statutes and Regulations
of the Institute.
• I hereby certify that the entries made by my ward in this form are correct to the best of my
knowledge and belief.

Place ___________________ ______________________________________

Date: ___________________ Signature of the Parent / Guardian
Full Name _____________________________
Note:
1. In case of any change in address and/or telephone numbers, parents are requested to kindly intimate the same in writing or by e-mail to the
Dean (Academic) email: dean.ac@nitjsr.ac.in.
2. The spelling of the name written (in Hindi and English) above will appear in your degree certificate, therefore, you are requested to write
your name correctly without any mistake as per high school certificate.

FOR OFFICE USE ONLY

ID No: 2 0 2 2 P G

Discipline:

_______________________________ _______________________________
Signature of Verifying Officer Signature of Dy. Registrar (Academic)
Full Name:
___________________________
Signature of Dean (Academic)