MALAVIYA NATIONAL INSTITUTE OF TECHNOLOGY JAIPUR
J.L.N. Marg, Jaipur-302017
OFFICE OF THE DEAN, ACADEMIC
REGISTRATION FORM
Academic Session 2025-26
Semester : ODD Date Of Registration: 19-08-2025
Student ID 2025UEC1381 Branch ELECTRONICS AND COMMUNICATION ENGINEERING
Form to be filled in Capital letters (As per Secondary School Certificate)
1. Student Name (in English) KARAKALA RAM MANOHAR
Student Name (in Hindi)
2. Father's Name (in English) KARAKALA MADHUMOHAN
Father's Name (in Hindi)
Father's E-mail ID : madhumohankarakala@gmail.comFather's Mobile No : 9642964814
3. Mother's Name (in English) KARAKALA MAHESWARI
Mother's Name (in Hindi)
Mother's E-mail ID : Mother's Mobile No : 8688468804
4. Date of Birth : 15-12-2006 5. Nationality : Indian 6. Country : INDIA
7. Gender: MALE 8. Marital Status : SINGLE
9. Blood Group : A+ 10. Adhar Card No. of the Student: 443073101453
11. Physical Handicapped : NO Passport No : if (DASA / ICCR / MEA )
12. Name of Programme : B.Tech.
Category : SC Allotted Category : SC AIR/GATE Score :
If M.Tech./Ph.D. Full Time Sponsored Full Time: Part Time :
If Sponsored
If qualified : YES / NO Gate : YES / NO NET : YES / NO
13. Admitted under Category : OC/OBC/SC/ST/EWS/DASA-SAARC/DASA-NON SAARC/DASA-CIWG/ICCR/MEA
14. Day Scholar / Hosteller I am willing to take Hostel facility in campus
15. Address for Communication
77/534. Mujafar Nagar , Kallur estate
City/Town : Kurnool District : Pin Code : 518003
ANDHRA
Country : INDIA
State : PRADESH
Phone No/ (Res) : (Office) :
Mobile No. (Student) : 9642964814 Email (Student) : rammanohar1453@gmail.com
Permanent Address
77/534 Mujafar Nagar , Kallur estate , /
Kurnool ,ANDHRA PRADESH,INDIA,518003
16. Local Guardian (If Any) Name : Relationship with Student :
Email ID : Mobile No. :
Address
Phone No.
17. Details of INSTITUTE Fee (Except mess fee)
Challan No : 2025/106240 DD No. : Online Dated : 19-08-2025
Amount (Rs.) : 36837.06 Name of Bank (DD):
18. Qualification
S.No. Degree Discipline Board/Univ.Inst./ Year % Mark/CGPA/Degree
1.
2.
3.
4.
5.
6.
19. Declaration
I am eligible for the registration
I do hereby agree to abide by all the Ordinances/statues and regulations of the Institute inforced 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 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 it is in the interest of the Institute to do so.
I understand that if any document is found forged at any stage during my course of study, will automatically
stand cancelled and legal action would be taken against me.
I have submitted all the documents listed in below table.
List of documents to be submitted by the student at the time of admission
S.No. Particular Submitted Yes/No
Selection order issued by DASA/MEA/ICCR/Provisional Allotment letter issued by
1.
CSAB/CCMT/CCMN (as the case may be)
SAT Score Proof in hard copy (print out)/JEE Main Score Card/Rank Card/GATE
Score Card [to be submitted in original]/proof of qualifying NET (as the case may
2.
be).
Document Verification Certificate issued by Reporting Centre
3. Date of birth certificate (X class pass certificate/marksheet)
4. Mark sheets of qualifying examination
5. Character certificate form the last school/Institute attended in original
6. Transfer Certificate in original
7. Migration certificate submitted in original
8. Medical certificate issued by the recognized/reputed hospital
9. Category Certificate (SC/ST/OBC-NCL/EWS).
10. Certificate of Physical Handicapped (if applicable)
ID Proof (In case of Indian students- Adhar card/Voter ID Card) In case of foreign
11.
students (DASA/MEA/ICCR)- pass port/visa/ citizen ship card
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S.No. Particular Submitted Yes/No
12. ID Proof [In case of Children of Indian Workers in Gulf Countries (CIWG)]
(1) Copy of the passport of the parent working in the gulf country
(2) Copy of Parent's visa
(3) Copy of Parent's Work Permit (If any)
(4) Certificate from the company/organization as proof that parent is working in
gulf country as per Appendix III of UG Brochure
13. AIDS free certificate issued by the recognized/reputed hospital (DASA/MEA/ICCR)
14. Gap certificate
NOC from employer (application in case of M. Tech./M.Plan./Ph.D. sponsored
15.
candidate)
Income Certificate (Family / Guardian Annual Income form all sources ) duly issued
16. from the concerned Prescribed competent reveune officer,not below the rank of
Tehsildar
UNDERTAKING
KARAKALA
I KARAKALA RAM MANOHAR S/o MADHUMOHAN hereby undertake to submit the
following pending document by 15-09-2025 otherwise my admission in MNIT Jaipur in
B.Tech programme shall be treated as cancelled and the responsibility of the same shall solely rest
on me.
List of Pending Documents to be submitted
S.No. Particular
1.
2.
3.
4.
5.
6.
7.
8.
Date : 20-08-2025 Signature of Student :
Checked By Verified By
Name Name
Dealing Assistant Academic Section Officer Incharge
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MALAVIYA NATIONAL INSTITUTE OF TECHNOLOGY JAIPUR
THE HONOUR CODE
I KARAKALA RAM MANOHAR ID No. 2025UEC1381 do hereby undertake
that as a student at MNIT Jaipur:
(1) I will not give or receive aid in examinations; that I will not give or receive unpermitted aid in class work, in preparation of
reports, or in any other work that is to be used by the instructor as the basis of grading; and
(2) I will do my share and take an active part in seeing to it that others as well as myself uphold the spirit and letter of the Honour
Code.
I realize that some examples of misconduct which are regarded as being in violation of the Honour Code include:
Copying from another's examination paper or allowing another to copy from one's own paper;
Unpermitted collaboration;
Plagiarism;
Revising and resubmitting a marked quiz or examination paper for re-grading without the instructor's knowledge
and consent
Giving or receiving unpermitted aid on take-home examinations
Representing as one's work the work of another, including information available on the Internet; and
Giving or receiving aid on an academic assignment under circumstances in which a reasonable person should
have known that such aid was not permitted.
Committing a cyber offence, such as, breaking passwords and accounts, sharing passwords, electronic copying,
planting viruses, etc.
I accept that any act of mine that can be considered to be an Honour Code violation will invite disciplinary action.
Student's signature :
KARAKALA RAM
Name : MANOHAR
Date : 20-08-2025 ID No. : 2025UEC1381
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MALAVIYA NATIONAL INSTITUTE OF TECHNOLOGY JAIPUR
Declaration and undertakings by the Parents and Students
I undertake to pay all Institute fees and subsidiary fund dues in respect of my Son , Mr.
KARAKALA RAM MANOHAR who is being admitted to the MNIT Jaipur. My Profession
is and my monthly income is Rs. I have sufficient
means to defray the expenses to be incurred during his/her stay at the institute.
I hereby assure that my ward/son/daughter will abide by all Ordinances/Statues 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: Signature of Parent/Guardian
KARAKALA
Date : 20-08-2025
Full Name : MADHUMOHAN
Undertaking of awareness of medical facilities at MNIT Jaipur Dispensary
I KARAKALA MADHUMOHAN Father/ mother / guardian of
Mr. KARAKALA RAM MANOHAR hereby declare the following in respect of
my ward to be admitted to B.Tech course at MNIT, Jaipur.
I am aware of the following facts:
i. The MNIT, Jaipur Dispensary located in the campus and run by MNIT, Jaipur for its community has limited
facilities.
ii. The MNIT, Jaipur Dispensary may not be adequate for treatment of any patient with chronic or serious ailments.
iii. It is the responsibility of the guardians to take care of their wards for outside treatment.
Despite the best efforts on the part of MNIT, Jaipur if any untoward thing happens to my ward, I shall not hold the Institute
accountable for the same and will not seek any financial help or compensation for the same from any court of law.
Date20-08-2025 Signature of Parent
Undertaking for not indulging in any kind of ragging and indecent behaviour towards juniors as a senior student
I KARAKALA RAM MANOHAR S/o
Mr. KARAKALA MADHUMOHAN hereby give an undertaking that I will not
indulge in any kind of ragging or indecent behaviour towards my junior students during my entire stay at MNIT,
Jaipur. Also, I am aware of the fact that at any stage if I am found to violate the above undertaking, the MNIT, Jaipur
authorities may take suitable action that includes expelling me from the Institute. I will not challenge action taken for
such violation in any court of law.
Counter Signature of the
Signature of Student
Parent/Guardian
Undertaking by the student for not owning motor driven vehicles for Commuting inside MNIT Jaipur campus
I KARAKALA RAM MANOHAR S/o
Mr. KARAKALA MADHUMOHAN hereby give an undertaking that I will not
own/drive motor driven vehicle for commuting inside the MNIT Jaipur authorities may take suitable action that
includes expelling me for the Institute.
Counter Signature of the
Date20-08-2025 Parent/Guardian Signature of Student
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Checklist for office use
S.No. Particular Verified Pending
Selection order issued by DASA/MEA/ICCR/Provisional Allotment letter issued by
1.
CSAB/CCMT/CCMN (as the case may be).
SAT Score Proof in hard copy (print out)/JEE Main Score Card/Rank Card/GATE
2. Score Card [to be submitted in original]/proof of qualifying NET (as the case may
be).
3. Date of birth certificate (X class pass certificate/marksheet).
4. Mark sheets, certificate & Degree of qualifying examination.
5. Character certificate form the last school/Institute attended in original.
6. Transfer Certificate in original.
7. Migration certificate submitted in original.
8. Medical certificate issued by the recognized/reputed hospital.
9. Category Certificate (SC/ST/OBC-NCL/EWS).
10. Certificate of Physical Handicapped (if applicable).
ID Proof
11. In case of Indian students- Adhar card/Voter ID Card.
In case of foreign students (DASA/MEA/ICCR)- pass port/visa/ citizen ship card.
12. ID Proof [In case of Children of Indian Workers in Gulf Countries (CIWG)]
(1) Copy of the passport of the parent working in the gulf country
(2) Copy of Parent's visa
(3) Copy of Parent's Work Permit (If any)
(4) Certificate from the company/organization as proof that parent is working in
gulf country as per Appendix III of UG Brochure
13 AIDS free certificate issued by the recognized/reputed hospital (DASA/MEA/ICCR).
14 Gap certificate.
NOC from employer (application in case of M. Tech./ M.Plan./ Ph.D. sponsored
15
candidate)
Checked By: Verified By:
Name: Name :
Dealing Assistant Academic Section Officer Incharge
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