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Admission-Form

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Martin Nadar
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83 views2 pages

Admission-Form

Uploaded by

Martin Nadar
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Admission/Registration Form

1. Name of Institute :_ ____________________________________________________ Please affix


a passport
2. Course for which admitted :_ ____________________________________________________ size photo
3. Name of Student :_ ____________________________________________________
4. Father’s Name :_ ____________________________________________________
5. Mother’s Name :_ ____________________________________________________
6. Father’s Occupation Govt. Job Private Job Businessman Other
7. Annual Income :_ ____________________________________________________
8. Date of Birth
Date Month Year

9. Category General OBC SC/ST FG


10. Address (Local) : __ _ _ _ _ _ _
__ _ _ _ _
__ _ _ _ _
__ _ _ _Pin Code _

11. Address (Permanent) : __ _ _ _ _ _ _


__ _ _ _ _
__ _ _ _ _
__ _ _ _Pin Code _
12. Mobile No.
13. Qualifying Exam :
S.No. Name of Exam Board/University Passing Year Percentage Remark

1.

2.

3.

4.

5.

6.

7.
14. Documents Submitted : Please tick ()
S.No. Name of Documents Original Photocopy Remark
1. High School Mark sheet
2. Higher Secondary Mark sheet
3. Graduation Mark sheet
4. Post Graduation Mark sheet
5. Diploma Mark sheet
6. Character Certificate
7. Transfer Certificate
8. Migration/Provisional Certificate
9. Domicile Certificate
10. Caste Certificate
11. Income Certificate
12. Other Certificate

Date : ____ _ _ Signature of Student: __ _ _

Declaration by Student/Parent/Guardian
Self/on behalf of my ward hereby declare that:
1. The information given by me in the application form and all enclosures are true to the best of my
knowledge. However, should it, be found that any information/enclosures therein are
untrue/wrong I am/my ward liable to be disqualified for admission.
2. If I am/my ward selected for admission I am/my promise to abide by the rules & regulations of
the Institute/University and maintain the discipline in the institute and the hostel.
3. Initially the admission is provisional and is subject to confirmation from the counseling authority
concerned University and State Government.
4. It is compulsory for me/my ward to appear for online counseling at any place directed by the
counseling authority with in the specified date and time failing which I/my ward’s registration
will be automatically cancelled without any refund of fee.
5. I understand that if I get my admission/registration cancelled the fee deposited by me is non-
refundable.
6. Cancellation of admission/registration is not possible without paying the full fees for the entire
course.
7. I undertake to abide by the “Student Leaving Midstream” clause of the prospectus and agree to
pay fees for the whole course if I leave course in midstream.
8. Any dispute is subject to Sehore Jurisdiction.

Signature of Declarer __ _ _
Date : ____ _ _ Name of Declarer __ _ _
Place : ____ _ _ Relationship with Candidate __ _ _ _

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