Form No. :

BIJU PATNAIK NATIONAL STEEL INSTITUTE

Affix self attested passport size photographs

RAMA BALLAV ROAD, PURI

ORISSA – 762 001

APPLICATION FORM

Course Applied for : ___________________________________________________

FOR OFFICE USE ONLY

SELECTED : YES NO JOINED : YES NO

Date of Joining : ROLL NUMBER

1. Name in Block Letters : _________________________________________________________

2. Father/ Guardian’s Name : _________________________________________________________

3. Relationship : _________________________________________________________

(If other than father)

4. Address for Communication : _________________________________________________________

__________________________________________________________

__________________________________________________________

____________________________________Pin __________________

Tel No. :

e-Mail :

5. Permanent Address : _________________________________________________________

__________________________________________________________

__________________________________________________________

____________________________________Pin __________________

6. Date of Birth : DD MM YYYY 7. Age on : _____ Years _______ Months

(30^th APR 2008)

8. Sex : Male Female 9. Nationality : _______________________

10. Category : SC ST OBC GENERAL

(Give a Tick Mark)

11. Educational Qualification :

Examination Passed	Board / University	School / College / Istitution	% age of Marks	Year of Passing	Class / Division	Subject Taken
10^th (Matric)
+2 Sc.(Inter)
Diploma Engg.
+3 Sc. (Degree)
BE / B Tech. (Degree)
Other

12. Working Experience (In prescribed format) :

(If space is not sufficient please

attach a separate sheet)

13. Extra Curricular Activities :

(Include any Professional Certificate)

DECLARATION

I, here by declare that the information furnished above is true to best of my knowledge and belief. I understand that any incorrect and incomplete information will disqualify my candidature.

Signature of Candidate’ s Father / Guardian Signature of the Candidate

Date : Date :

FOR OFFICE USE ONLY

Received on : Index Number :

Application Completed : YES / NO

All required Mark Sheets Enclosed : YES / NO

Bank Draft Enclosed : YES / NO

Remarks if any :

Verified by

Enclosures List

(Please check the enclosures and make a tick mark in the enclosures)

1. Xerox copy of Matric Certificate

2. Xerox copy of Matric Mark Sheets

3. Xerox copy of Intermediate Certificate

4. Xerox copy of Intermediate Mark Sheets

5. Xerox copy of Diploma Ceritficate

6. Xerox copy of Diploma Mark Sheets

7. Xerox copy of Degree (B. Sc. ) Certificate

8. Xerox copy of Degree (B. Sc. ) Marksheets

9. Xerox copy of Degree Engg. Certificate

10. Xerox copy of Degree Engg.Marksheets

11. Three Passport size Photographs

12. Bank Draft

13. Experience Certificate (In prescribed format)

Bank Draft No.

Date of Issue

Issuing Bank

Amount

N. B. : The Enclosure sheet should be with the application Form

GENERAL INSTRUCTIONS

The candidates seeking admission to BPNSI should follow those instructions strictly.

The candidate should go through the prospectus carefully and acquaint with all requirements :

1. He / She should satisfy the eligibility criteria as given in the prospectus.
2. The candidate should apply through Prescribed Application Form complete in all respect or submit it online.
3. Complete address with Postal Pin Code & Telephone Number should be written in the Application Form.
4. Application Form should be filled up in own handwriting in BLOCK LETTER in English only, using blue / black ball point pen.
5. Date of Birth, candidate’s Name should be exactly same as in 10^th Pass Certificate.
6. Overwriting, cutting, erasing or wrinkle on the Application Form and incomplete Form may lead to rejection of Application and should be avoided. Any error arising on this account shall be the responsibility of the candidate.
7. Options filled by the candidate can’t be changed at a later stage.
8. The Enclosure sheet should be with the application Form.
9. Application received after the due date will not be considered.
10. BPNSI will not be responsible for any postal delay / irregularity / loss in postal transit of the application form.
11. The Application Form duly filled in should be sent to the Director, Biju Patnaik National Steel Institute, Rama Ballav Road, Puri – 752 001, Orissa” so as to reach positively on or before 18^th April 2008, 5 P.M.
12. Sending of Application Form

The prescribed application form duly filled in should be submitted in person / by post (Registered post / Speed Post ).

The following enclosures should be enclosed with the Application form. It is not required to enclose the copy of any certificates / Marksheets . Candidates applying Online should enclose the bank draft.

Enclosures :

1. Xerox copy of Matric Certificate

2. Xerox copy of Matric Mark Sheets

3. Xerox copy of Intermediate Certificate

4. Xerox copy of Intermediate Mark Sheets

5. Xerox copy of Diploma Ceritficate

6. Xerox copy of Diploma Mark Sheets

7. Xerox copy of Degree (B. Sc) Certificate

8. Xerox copy of Degree (B. Sc) Mark sheets

9. Xerox copy of Degree Engg. Certificate

10. Xerox copy of Degree Engg. Mark sheets

11. Three Passport size Photographs

12. Bank Draft

13. Experience Certificate (In prescribed format)

IMPORTANT DATES :

1. Opening date of sale of Application Kit : 7^th Apr 2008

2. Last date of receipt of Application : 18^th Apr 2008

3. Start date of Admission : 21^th Apr 2008

4. Closing date of Admission : 30^th Apr 2008

FOR DETAILS CONTACT :

BIJU PATNAIK NATIONAL STEEL INSTITUTE

Rama Ballav Road,

Puri – 752 001, ORISSA

Ph : 06752 –232880, 232820

e-Mail : bpnsipuri@sify.com

Web site: www.bpnsi.org