1. Course

   B. ARCH

   M. ARCH

2. Discipline

   :

3. Name (In Capital Letters)

   Surname

   First Name

   Middle Name

4. Father’s Name

   :

5. Guardian’s Name
   (If Father is not alive)

   :

6. Date of Birth

   In Figures

   :

   In Words

   :

7. Nationality

   :

8. Religion

   :

9. Mother Tongue

   :

10. Blood Group

    :

11. Gender

    Male:

    Female:

12. Aadhaar Number

    :

13. Whether belongs to any Reserved Category

    SC

    ST

    OBC

    PH

    GREEN CARD

    EX - SERVICEMEN

    NA

    (Certificate from competent authority to be produced at the time of college reporting)

14. Occupation of Father / Guardian

    :

15. Annual Family Income

    :

16. Address of Father / Guardian

    :

    CORRESPONDENCE ADDRESS

    

    • NAME

      :

    • C/O

      :

    • AT

      :

    • P.O

      :

    • DIST

      :

    • PIN

      :

    • PHONE (Father / mother)

      :

    • PHONE (Student)

      :

    • EMAIL (Father / mother)

      :

    • EMAIL (Student)

      :

    PERMANENT ADDRESS

    

    • NAME

      :

    • C/O

      :

    • AT

      :

    • P.O

      :

    • DIST

      :

    • PIN

      :

17. Academic Records (Attach attested Xerox copies of certificates and mark sheets) :

    SL
    No.

    Name Of Exam Passed

    Board / University

    Year of Passing

    Max. Marks

    Marks Secured

    % of Marks

    Subject(s)

    Name of the School/College last attended

    Address

18. Jee Main Paper-2 score card

    ( If any )

    :

19. NATA score card

    ( If any )

    :

20. 12th/Diploma Mark sheet

    :

21. Caste certificate

    ( If any )

    :

22. If admitted, I propose to reside (Put Tick Mark in appropriate place)

    In Hostel

    With my Parent / Guardian

    In Private Accommodation

23. Upload transaction receipt

    ( If paying online, please upload transaction receipt )

    :

24. Upload Bank Details

    ( If paying Offline, please put Bank Details )

    Bank Account Name- ABIT-PILOO MODY COLLGE OF ARCHITECTURE

    Bank Account Number- 302001012011001

    IFSC Code- UBIN0571814

    Bank- UNION BANK OF INDIA

    Branch- MARKAT NAGAR

I here by declare that, I will abide by all the rules and regulations of the Institute after my admission into the said Institute. I extend voluntarily the authority to the management of PILOO MODY COLLEGE OF ARCHITECTURE, ABIT-PMCA GROUP OF INSTITUTIONS, CUTTACK to take necessary actions in case of any breach of rules, worthy and appropriate for the healthy academic prospects of mine. I also declare that I have gone through the counselling / admission process and have understood the course pattern and am taking admission with my own consent.