JYOTI NIVAS COLLEGE

Hosur Road, Bangalore

APPLICATION FORM FOR

FOR OFFICE USE ONLY
Admit to ___________________________

Admission No. _________________ Date ___________

Note : Read the instructions before you fill
information will be rejected.


Name of the applicant ________________________________________________________________
(as mentioned in the PUC marks card)

Date of Birth_____________________ Country
(as mentioned in the S.S.L.C / ICSE marks card)

Nationality_____________________________________________________________________________________

Religion Roman Catholic Hindu Muslim
Other Christian Caste ______________
Sub Caste ___________

Category SC ST Cat I Cat II(A) Cat II(B) Cat III(A)

Sports Person Yes No

Passport No. Validity Date

Name of the College last attended ___________________
_____________________________________________

Name of the Board_______________________________

Exam passed ___________________________________

Month/year of passing____________________________

Reg. No._______________________________________
No. of attempts__________________________________



Overall percentage of the marks obtained_____________



Details of the marks obtained











Average % in Languages
Subject Max Marks

English
Language





Total
JYOTI NIVAS COLLEGE AUTONOMOUS
Hosur Road, Bangalore 560 095

APPLICATION FORM FOR DEGREE COURSES
Application No.
___________________________
Admission No. _________________ Date ______________ Registration No.
fill in the Application form. Application Forms with

Name of the applicant ________________________________________________________________
Country __________________________ State ________
(as mentioned in the S.S.L.C / ICSE marks card)
_____________________________________________________________________________________
Hindu Muslim
______________ Caste ________________ ________________
___________ Sub Caste______________
SC ST Cat I Cat II(A) Cat II(B) Cat III(A) Cat III(B)
No Handicapped Yes No Blood Group

Visa No Validity date
______________________. Courses Available
_____________________________________________ P.ECO.S H.ECO.S P.ENG.S
_______________________________ PCM PME C
_________________________
____________________________ __________________________
____________________________ Language option for Degree
No. of attempts__________________________________ Kannada Hindi French Add. English
Overall percentage of the marks obtained_____________ Others____________________


Permanent Address__________
________________________________________
________________________________________
________________________________________

Local Address____________________________
________________________________________
________________________________________
________________________________________
_______________________________________

in Optional Subjects
!"

Marks Obtained


AUTONOMOUS
with incomplete or Inaccurate
Name of the applicant ______________________________________________________________________________
________________________
_____________________________________________________________________________________
Others (Mention)
________________ ________________

Cat III(B)
Blood Group__________________
Validity date
P.ENG.S H.ENG.S
CBZ B.COM
Your Choice
__________________________
French Add. English
Others____________________
Address________________________
________________________________________
________________________________________
________________________________________
Local Address____________________________
________________________________________
________________________________________
________________________________________
_______________________________________


Affix
photograph

Ashith Swaraj M
03/10/1995 India Karnataka
Indian
Billava
ab+
Govt Pu College,Bockapatna
Karnataka Pu
Puc Examination
march 2014
512062
1
60.83
B.A
100 81
100 30
Economics
Geography
Business Studies
Accountancy
100
100
100
600
100
50
61
85
58
365
55.5 63.5
N0-2,Ground Floor
Shameem Apt,Opp Yenepoya Medical College
Derlakatte
Mangalore-575018

Fathers Name____________________________ Mothers Name___________________________________
Qualification_____________________________ Qualification_______________________________________
Occupation_______________________________ Occupation________________________________________
Annual Income____________________________ Annual Income_____________________________________
Phone/Mobile No _________________________ Phone/Mobile No___________________________________
E-mail_________________________________ E-mail___________________________________________

Guardian Name & Address________________________________ Phone/Mobile No__________________________

________________________________ E-Mail _______________________________
GAMES and ATHLETICS Participated in Debate/Essay writing/Drawing/Quiz etc.
Participated in..Game/Event Completed...
at....Level and Prizes won...
Prizes won.. at.Level


We expect our students to take active part in one or two of the following. Indicate your preference since the number in
each group is limited

NCC NSS GAMES & ATHLETICS ROTERACT
DEBATE CREATIVE WRITING DRAMATICS AICUF
QUIZ COLLEGE CHOIR LITERARY ASSOCIATION E-CELL
ADVENTURE CLUB OUTREACH PROGRAMME

DELARATION

I promise to abide by the rules and regulations of the college. I hereby agree to undergo the NCC/NSS/Physics/Cultural
Training prescribed by the college during the period of my studies in college. I shall take part in at least one of the co-
curricular activities offered by the college.

I shall attend either religious or Moral Education classes. I also declare that the statements I have made in the application
are correct. I shall be regular in attending the college.

Place ______________
Date ______________ _________________________
Signature of the Candidate

DECLARATION BY THE PARENT/GUARIAN

I shall be responsible for the payment of all fees. I shall also stand responsible for the conduct and good behavior of my
daughter/ward during the period of her college career. I understand that a student may be asked to leave the college at any
time for misbehavior and irregular attendance.

Place ______________
Date ______________ __________________________
Signature of the Parent/Guardian


2
Manohar Raj
Pune