REGISTRATION FORM
MCA/MBA

For admission to the degree programmes in DISHA, recognized by A.I.C.T.E. and affiliated to U.P. Technical University, Lucknow. U.P.
A) SEE – UPTU –
Roll No. Gen Rank Category Rank
B) AIEEE / AIMCAT
Roll No. State Rank AIR Rank
C) Any other exam
Roll No. Rank Mention Name
Name Father's Name CATEGORY:
D.O.B Nationality SEX
State of Domicile        
Correspondence Address Land Line Mobile
Permanent Address Land Line Mobile
Gardian Address Land Line Mobile
ACADEMIC QUALIFICATION
Examination Passed School/College Board/University Year of Passing Over All %age PCM %age Subject Taken
10th
12th
Graduation
Any Other
12. Do you require hostel accommodation: Yes / No:…………………..
13. The following documents must be enclosed with the application form: -
(i) Photocopy of Mark-sheets of qualifying examination
(ii) Photocopy of Certificate of Domicile (Other than U.P. Board)
(iii) Photocopy of Caste Certificate (in case of any reserved category)
(iv) Photocopy of valid rank letter (if applicable)
Declaration:
I confirm that the information provided by me in this application form is accurate and correct. I understand that in the event of my admission, if any information provided here by me is found incorrect, my admission could be cancelled without notice.
I further declare that I have never been debarred from any examination or rusticated by any Institution/ University . I also declare that I have not been convicted by any Court of Law in India or abroad at any time for any criminal offence and sentenced to imprisonment as well as no proceedings are pending against me.
I further confirm and undertake to abide by the Rules and Regulations as framed from time to time by the U. P. Technical University, Lucknow as well as by the College.