10th ANNUAL CONVOCATION OF KIIT UNIVERSITY
8th November 2014
BHUBANESWAR

Please Fill up the form as instructed.
Full Name is required
 
Parents Name Enter Father's name
  Enter Mother's name
 
Institute Roll No. Registration No.
Course Completed Branch or Field
e.g. Sep 2013
 

e.g. Bhubaneswar, Cuttack, etc. Enter district of City/Town.
Enter State Pincode of the address
Enter telephone no. (optional) Contactable Mobile No.
Enter your E-Mail address currently in use.  
 

Draft Amount: Attending Rs. 500/- (US$8.16 for NRI and SFFS Category)
Details of Demand Draft, drawn in favour of KIIT University, Bhubaneswar, payable at Bhubaneswar, enclosed:

Name of the Bank issued the D.D. Drawee Bank
Name on D.D. D.D. Number
Bank Branch name Issue date of D.D.
D.D. Code Amount of D.D. in Rupees
If in dollar put a "$" sign. e.g. $3.27