-: Application Form :-

1. ( For Office Use Only ) Date……/……../2019

Form Number ………………………………

Course Name …………………………………………..

Branch …………………………………………………..

2. General Information (Fill As Per Student 10th Mark sheet in BLOCK LETTERS)

Student Name…………………………………………………………………………………………………………………………………………………

Father Name……………………………………………………………………………………………………………………………………………………

Mother Name…………………………………………………………………………………………………………………………………………………..

Date of Birth( In Digits) : ………………………………………… Gender ………………………… Category ……………………………….

Permanent Address…………………………………………………………………………………………………………………………………………

……………………………………………………………………………………………………………. Pin Code …………………………………………

Local Address …………………………………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………… Pin Code ………………………………………….

Mobile Number ……………………………………………………… E- Mail Id ………………………………………………………………………

Blood Group…………………………… Nationality …………………. Religion ………………………………….

Aadhar number …………………………………………………………. Samagra Id ………………………………………………………………..

Any Disability (If Yes Attach Medical Proof ) ………………………………

3. Qualification Details
Course Name Passing Year Board Name Marks Obtained/Total Percentage

Guardian’s Signature Student’s Signature

4. Have you applied or registered other course of study in any other Institution/University in India.
Yes/No
If yes, Please give the name of course & institution is
……………………………………………………………………………………………………………………………………………………
5. Are you recipient of any kind of scholarship during your past studies. if yes, please give
details…………………………………………………………………………………………………………………………………………
6. DECLARATION BY THE APPLICANT
I……………………………………………………………Son/Daughter/Wife
Shri/Smt……………………………………………Declare that the self attested photocopies of educational
document qualification to take admission in this Course/Program.
If, I am admitted in the university, I self observe full discipline
and maintain a goof conduct and behavior during my sojourn in the university. I shall abide by
rule, regulation and ordinance of the university as they are now and may be constituted and
declared in future. I understand that my involvement is found in any indiscipline like ragging,
theft, abusive language sarcastic language or such action why which if any person, Male/Female
students or any employee of the university feels hurts and repeatedly violation of disciplinary
rules etc, my admission can be cancel at any stage of course/program.
After getting admission in the university it will not be
cancelled at any chance. The paid amount of fee will not be refundable.

Place: ……………………
Date: ……………………. Left Hand Thumb Impression Student’s Signature

FOR OFFICE USE ONLY

Recommended/Not recommended for admission
…………………………………………………………………………………………………………………………………………………..

Admission accepted/not accepted Admission Committee