Singhania University: (Fill Up and Submit This Form)

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SINGHANIA UNIVERSITY

OM PARAMEDICAL & TECHNICAL EDUCATION


EXAMINATION FORM
(Fill up and submit this form)

Enrollment No…………………… Name: ………………………………………. paste


Photo or
Father Name……………………………...Mother Name…………………………… send scan
copy pix
E mail Id………………………………. …….. ……Mob No….…………………. 120/90

Date of birth: …………………………………… Category: Gen/OBC/SC/ST

Address: ……………………………………..............................................................................
Dist……………………………………. State ………………. Pin code ……………………...

Name of Course Applied For: …………………………………………Stream…………….


Semester/Year: ……………………….
Choice of Exam : Online or Written (………………………)
Note: Candidates opted for written exam have to come to Delhi center. We have the
provision of online examination for all the places. Kindly fill up the Place of online
examination where you will be available at the time of examination (Name of Place)
…………………………...

DECLARATION BY STUDENT
I……………………………………. Son/D/o/Wife of……………………………… declare
that the above information submitted by me is true and correct to the best of my knowledge.
If found incorrect than University shall be free to cancel my examination form. I will follow
all the rules and regulation of examination prescribed by the university. I was totally briefed
regarding the course and about the validity of university before taking the admission and I
was fully satisfied and verified everything before taking the admission.
I have PAID/NOT PAID complete semester fee. (Tick as applicable)
Place……………………
Date: …………………… Signature of Candidate
----------------------------------------------------------------------------------------------------------------
EXAMINATION FEE DETAIL
(To be filled by the candidate)
Examination fee Rs. ……………. deposited in ………………………………… (Bank name)
on date………………. If deposited directly in bank account send the scan copy of deposit
slip and write your name on deposit slip)
Note: Exam Fee is Rs. 4000/- up to 10th June 2021.
Note: If already paid along with semester fee, then write here ……………………. (Paid/Not Paid)

Sign of In-charge Academic Centre

Date: ……………………………
(Singhania University)

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