Enrolment No. Application No. (Forefice use on) SCHOOL OF DISTANCE EDUCATION ‘Aft recent passport BHARATHIAR UNIVERSITY here COIMBATORE - 641 046 Do Not Stapl Course Applied for # ‘Specimen Signature of the candidate (inside box) APPLICATION FOR ADMISSION (Pasa tex v) [Fresh Admission] Lateral Entry [Direct Admission] Re-admission | Transfer during the Academic Year 20. 20 1 Calendar Year 20, (To be filed in by the candidate in his /her own handwriting legibly IN CAPITAL LETTERS IN ENGLISH) PaynariDei ame & Branch of fe Bark — Calan Doma ra No, ae Amount Paid : Rs. (Rupees, ) Name of the Canto Gente For admission croc at tho Universit kindly mention Schoo! of Distance Education as name ofthe Spot Admission Contre and TNO2Z01 as Contre Code; Please refer prospectus or Centre Name and Code 1. Name of the Applicant (As per SSLC / H. Se. Record): (Attach Gazette notification copy fname changed) 2,Name of the Father | Mother | Guardian | Husband: 3. Address for Communication: Pincode District State: Mobile No. PhonoNo E-mail 4, Date of Birth 5.Sox Male Female 4 Admission fo th course desired by the canciteis purely provisional and the University resorves the right to withdraw th otfor ofthe course ‘atany time due to administrative reasons6. Nationality, 7, Sociaistatus[ sc | st [mac] Bc [aca] oc 8. Mother Tongue: 9, Family Annual Income : Rs. 10, Details of Qualifying Examinations passed: Pattern of Examination : 10+243 | 114143 | 10#3+2 / Others (Specify) ‘Subject | Mi Institution / University Near of of Sepa) SI.No.| Name of the Course ubject/ Mor | Inettution/Universty | Pesing | warns —_|(OSPAD/| + [sete 2,_ | Hse. /PUC/Pre-degree 3._| Diploma 4. [us 5. | PGDip 5. |Pc. (Should submit athe above corcates in orginal for veifcaion alongwith a sefofxerox copy. The orginal coicates willbe retumed immediatly ‘ater verification} 11, Areyouundergoing any othercourse?: Yes/No Ityes, Name of the Course Institution / University, 12, Preferred Language under Part- (For UG Applicants only) (Tami, Telugu, Kanade, Molayalam, Hind, Uru, Arabi and French ae offeredas language under Part) 43, Concession claimed in Tuition fee pl.tick (v): * 25% 00 concession - Teachors/ Defence & Police /Pross & Media (Proese undertne the specie category) Graduates of Bharathar Unversity Ex-servee men + 10% foe concession - Women anly * 100% fee concession - Above 60% Disablement only 25% lo concession - Uo 60% Disablement J A#PHTN GO 14, Are youwilling to attend Personal Contact Programmes organized by the University /Centre? Yes/No (Exemption avaiable for non lab and non professionalcourses only: not ling, please give undertaking in the enclosed format) e the Online PCP facility instead of regular PCP (forMBA candidates only)? Yes/No 15, Are you willing to util DECLARATION hereby declare thatthe particulars given above are correct. fany particulars given are found to be incorrect at any point oftime, | vill abide by the decisions ofthe University. wil if admitted, abide by the rules and regulations ofthe University. Place: Date Signature of the Applicant For Office Use only : [Educationally Qualified Yes/No Paid required fee: Yes/No [Attached all requited Certitcates : Yes/No Balance Amount to be paid Rs. [Sharing Pattern 5020 [TEE Fae] | Certicate verified : Yes/No Admitted : Yes [—] on No Reason ASO so AR DR DIR