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Server : Apache System : Linux profile 3.10.0-1160.88.1.el7.x86_64 #1 SMP Tue Mar 7 15:41:52 UTC 2023 x86_64 User : apache ( 48) PHP Version : 8.0.28 Disable Function : NONE Directory : /var/www/html/prashantkr/printphp/ |
<table><tr><td colspan=2 align=center> <h2>Indian Institute of Information Technology Allahabad<h2></td></tr>
<tr><td width=20% align=center><img src="logo.gif" width="75" height="78" /></td>
<td width=80% align=center>
(A University under Section 3 0f UGC Act 1956)<br>
A Centre of Excellence in Information Technology, Estd. By Min. of HRD, Govt. of India, New Delhi<br>
Devghat Jhalwa, Allahabad – 211012, U.P. (INDIA)<br>
Ph: 0532-2922025,2922067 Fax: 0532-2922081 <br>
Web: <a href="http://www.iiita.ac.in/">www.iiita.ac.in</a> Email: <a href="mailto:biomedical@iiita.ac.in">biomedical@iiita.ac.in</a>
</td></tr>
<tr><td colspan=2><hr><center><h3>Online Applicantion Form For Five Year Integrated M. Tech. in Biomedical Engineering 2013-2014 </h3></center></td></tr>
</table>
<form method="post">
<?php
include "javafunctions.inc";
include "functions.inc";
dbConnect();
$tbl = 'tbl_registration';
$id = $_REQUEST["id"];
if ($id) {
$rs = mysql_query("select * from $tbl where id='$id'" );
if ($rs) {
$o = mysql_fetch_object($rs);
$regid = $o->regid;
$fullname = $o->fullname;
$dob = $o->dob;
$gender = $o->gender;
$nationality = $o->nationality;
$category = $o->category;
$fathername = $o->fathername;
$mothername = $o->mothername;
$address = $o->address;
$state = $o->state;
$pincode = $o->pincode;
$phone = $o->phone;
$fax = $o->fax;
$email = $o->email;
$txntype = $o->txntype;
$txnnumber = $o->txnnumber;
$amount = $o->amount;
$depositdate = $o->depositdate;
$bankbranch = $o->bankbranch;
$discipline12 = $o->discipline12;
$board12 = $o->board12;
$year12 = $o->year12;
$percentage12 = $o->percentage12;
$appearing12 = $o->appearing12;
$discipline10 = $o->discipline10;
$board10 = $o->board10;
$year10 = $o->year10;
$percentage10 = $o->percentage10;
$appearing10 = $o->appearing10;
$photo = $o->photo;
$status = $o->status;
}else{
echo "Sorry! your details not available in the database.";
exit;
}
}
echo "
<table>
<tr><td valign=top>
<table>
<tr><td width=20%>Full Name </td><td width=80%> ".ucwords($fullname)." </td></tr>
<tr><td>Date of Birth </td><td> ".$dob." </td></tr>
<tr><td>Gender </td><td> ".ucwords($gender)." </td></tr>
<tr><td>Nationality </td><td> ".ucwords($nationality)." </td></tr>
<tr><td>Category </td><td> ";
switch ($category){
case "GE";
echo "General";
break;
case "OBC";
echo "Other Backward Class";
break;
case "SC";
echo "Scheduled Cast";
break;
case "ST";
echo "Scheduled Tribe";
break;
case "PD";
echo "Physically Disabled";
break;
case "MN";
echo "Minority";
break;
}
echo " </td></tr>
<tr><td>Father Name </td><td> ".ucwords($fathername)." </td></tr>
<tr><td>Mother Name </td><td> ".ucwords($mothername)." </td></tr>
<tr><td>Address for Correspondance </td><td> ".ucwords($address)." </td></tr>
<tr><td>State </td><td> ".ucwords($state)." </td></tr>
<tr><td>Pin Code </td><td> ".$pincode." </td></tr>
<tr><td>Contact No. </td><td> ".$phone." </td></tr>
<tr><td>FAX No. </td><td> ".$fax." </td></tr>
<tr><td>Email Address </td><td> ".$email." </td></tr>
</table>
</td> <td valign=top align=center nowrap><br>
<b>Application No. : ".$regid."</b><br><br>";
if (!$photo) {
echo "<img src='photos/demo.jpg' height=150 width=130 /> <br><br>";
} else {
echo "<img src='photos/$id.jpg' height=150 width=130 /> <br><br>";
}
echo "
<input type='text' size=20 /><br>
Signature of Candidate
</td></tr>
<tr><td colspan=2><hr>
<b>Application Fee Details </b><br>
</td></tr><tr><td colspan=2>
<table width=100%>
<tr><td>".$txntype."</td>
<td>Number ".$txnnumber."</td>
<td>Amount Rs. ".$amount."</td>
<td>Dated ".$depositdate."</td>
</tr>
<tr><td colspan=4>Bank & Branch issued ".ucwords($bankbranch)."
</td></tr>
</table>
<hr>
</td></tr>
<tr><td>
<b>Details of Qualifying Examination (*) passed or appearing.</b>
</td></tr>
<tr><td colspan=2>
<table border=1>
<tr><td>Name of the Qualifying <br>Examination<br> Passed/Appearing</td>
<td>Discipline</td>
<td>Board</td>
<td>Year of<br> Passing/Appearing</td>
<td>Percentage of Marks<br> Obtained</td>
<td>Final Result Expected by<br> (If Appearing)</td></tr>
<tr><td><b>Class XII</b></td>
<td>$discipline12</td>
<td>$board12</td>
<td>$year12</td>
<td>$percentage12</td>
<td>$appearing12</td>
</tr>
<tr><td><b>Class X</b></td>
<td>$discipline10</td>
<td>$board10</td>
<td>$year10</td>
<td>$percentage10</td>
<td>$appearing10</td>
</tr>
</table>
</td></tr>
</table>
";
?>
<br>
<b>Declaration by the applicant:</b>
<p align="justify">Certified that all information provided by me in this form is correct to the best of my knowledge and belief. I understand that any willful misrepresentation of facts will result in my admission being cancelled/expulsion from the Institute. If admitted, I shall abide by all the rules and regulations of the Institute.</p>
Date: ... ... ... ... ... ...
Signature of Applicant: ... ... ... ... ... ...
<br><br>
Place: ... ... ... ... ... ...
<br><br></td></tr>
<b>Declaration by Parent/Guardian</b>
<p align="justify">In the event of Mr./Ms. ... ... ... ... ... ... ... ... ... ... ... ... ... son/daughter/ward ... ... ... ... ... ... ... ... ... ... ... ... ... being admitted, I hereby give an undertaking to pay regularly all admissible dues to the Institute and Hostel till the completion of his/her studies. I undertake the responsibility for his/her good conduct. I am also aware that RAGGING is prohibited at the Institute and is treated as a cognizable offence at IIIT-Allahabad, under the Indian Penal Code and the directions of Hon'ble Supreme court of India and will ensure that he/she will not be involved in any ragging related activity. He/She shall maintain honour and dignity of the Institute.</p>
Date: ... ... ... ... ... ...
Signature of Parent/Guardian: ... ... ... ... ... ...
<br><br>
Place: ... ... ... ... ... ...
<br>
<br><hr>
* Attach attested copies of certificate, marksheet etc.<br>
<b>Checklist</b><br>
1. DD of the requisite application fee.<br>
2. Certificate of DoB, Category, Educational Qyalification etc.<br>
3. Equivalence Certificate from the Instituttion (in case Grades are awarded in the qualifying examination).<br>
4. Except DD all other xerox documents should be self attested.<br>
<hr>
<b>Please take a printout of your submitted registration details and keep the application no. for further communication. </b>
<hr>
<center>
<input type="button" value="Print" onclick="printpage()" />
<input type="button" value="Edit" onclick="parent.location='formindex.php?edit=1&id=<?php echo $id; ?>'" />
</center>
</form>