अभभरर ददरद घघषणद (Declaration By The Applicant)

1. मम एतददरद वववधवत घघषणद करतद हहह/करतत हहह कक उपभररकत दत गभत सभत सहचनदएए सतभ हम। तथभथ कघ वछपदभद भद गलत तरतकक सक पसतरत नहह ककभद गभद हह। ममनक
वववरवणकद मम पवकश पककभद सममनधत सभत सहचनदएए तरद तथभ पढ वलभक हम तरद मम इनकद अनरपदलन करएगद/करएगत। भकद कक गई पवववषभथ तरद सएलगनक पमदण-पतथ मम कघई
तरटट/ववसएगवत पदई जदतत हह तघ मकरद पवकश वनरसत कर कदभद जदए। ऐसत वसरवत मम मम शरलक वदपसत कक वलए ककसत भत पकदर कद ददवद नहह करएगद/करएगत।
2. मम भह घघषणद करतद हहह/करतत हहह कक ममनक सभत सव-पमदवणत पपत इस आवकदन पत कक सदर सएलगन कर कदभक हम।

3. ववशवववददलभ ददरद वनरमत वनभमदवलत कक तहत कर लपवत/कर लसवचव अरवद अनभ अवधकक त वभवक ददरद आवशभकतद पडनक पर वनभमदनरसदर कक गई ककसत भत पकदर कक
अनरशदसवनक कदभरवदहत मरझक सवतकदभर हघगत।

4. मम सभत वनभमथ/वनणरभथ और वववनभमथ कद पदलन करएगद/करएगत।

5. उततरदखणड मरकत ववशवववददलभ कक समसत परतकदएए कक वल उततरदखणड रदजभ मम हत समपनन हथगत।

1. “I hereby declare that the particulars stated in this application form are true to the best of my knowledge and belief. I have read the
prospectus and the admission/eligibility requirements as laid down by the University and I shall abide by them. In the event of
suppression or distortion of any fact in my application. My admission will stand cancelled at any point of time. In case my admission is
cancelled by the University due to any reason. I shall have no claim for refund of fee paid by me.
2. I hereby declare that I have attached all the required self-attested documents with this form.
3. Further I declare that I shall submit myself to the disciplinary jurisdiction of the Coordinator of the study centre. The Vice Chancellor
and Other authorities of the University who may be vested with the power to exercise discipline under the Act . The statutes. The
Ordinances framed by the University. In this regard these authorities have the right to take necessary disciplinary action.

5. All examinations of Uttarakhand Open University will be conducted only in Uttarakhand State.

सरदन (Place) अभभरर कद नदम (Name of the Applicant)

कदनदएक (Date) अभभरर कक हसतदकर (Signature of the Applicant)

अधभभन कक नन ददरद सतभदपन एवमम अगसदरण पमदण-पत

मम (समनवभक) एतददरद शत/शतमतत/सरशत (अभभरर कद नदम) VIJAY KUMAR

परत/परतत/पतनत SURESH KUMAR जघ इस अधभभन कक नन (कघड सवहत)

17062-Government Degree College मम पदठकम

MASO-21-M.A. Sociology (एए0ए0 एएएएएएएएएएएए) मम नदमदएककत हए हम, कद पवकश आवकदन पत

अगसदटरत करतद/करतत हहह। मकरक ददरद इस पवकश फदमर कक समसत पवववषभथ तरद सएलगन पमदण -पतथ कद महल पमदण-पतथ सक
वमलदन कर सतभदवपत कर वलभद गभद हह।
I (Coordinator, Study Centre) hereby forward this admission form of Mr./Mrs./Ms VIJAY KUMAR

Son/Daughter/Wife of SURESH KUMAR for admission in (Name of Study Programme)

MASO-21-M.A. Sociology (एए0ए0 एएएएएएएएएएएए) at (Study Centre name/Code)

17062-Government Degree College All the entries in this form and attached testimonials
have been verified by me after comparing the same with the original documents

सरदन (Place) अधभभन कक नन समनवभक कद नदम

Name of Coordinator, Study Center
अधभभन कक नन समनवभक कक हसतदकर

कदनदएक (Date) Sign. Of Coordinator, Study Center

मघहर(Seal)

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 Uttarakhand Open University
उतरदखएड मरक ववशववददलभ
Haldwani,Nainital | हलददनत ,नहनततदल

Regional Center /Study Center Information/Program Fee

Reference No. : AU24C0626220 Enrollment No. : 24335769
Regional Center : 17-Ranikhet

Study Center : 17062-Government Degree College

Programme : MASO-21-M.A. Sociology (एए0ए0 एएएएएएएएएएएए)

Year/Semester : 2-Semester Exam City : Chaukhutia

Study Medium : Hindi

Course Info : MASO-507 MASO-506 MASO-508 MASO-505

Fee :
Programme : 0.00 Additional: 0.00 Exam : 1000.00 Degree : 0 Late Fee : 0.00
Basic Information
Name : VIJAY KUMAR Name in Hindi : ववजभ कर मदर
Father Name : SURESH KUMAR Mother Name : PARWATI DEVI
Gender : Male Date of Birth : 26-Nov-2003
Mobile No. : 919411180898 E-Mail : [email protected]
National Indentity: AADHAR Card National Identity No. 835573191252
NAD Id : 835573191252 Country name in
Nationality: Indian case of others
State of Domicile: Uttarakhand Category: Scheduled Tribes
Handicap : No If physically
Territory : Rural challenged :
Religion : Hindu Economic Class: APL
Livelihood Status : Unemployed If livelihood:
Marital : Unmarried
Prison Inmate (Enrolled in an LSC created in a Prison) No
Eligibility:
Board/University:
Year of Passing:
Percentage:
Division:
Subject:
Complete address for obtaining correspondence/study material
VILLAGE SABHABAITHAK POST OFFICE RAMPUR BLOCK CHAU ALMORA Uttarakhand 263656 India

Academic Qualification

Examination Year University Per% Division Subject

10TH 2018 CBSC 76 FIRST HINDI ,ENGLISH, SCIENCE SOCIAL SCIENCE ,MATH

12TH 2020 CBSC 85 FIRST HINDI ENGLISH HISTORY GEOGRAPHY ECONOMICS

BA 3RD YEAR 2023 SSJU ALOMRA 59 SECON HISTORY SOCIOLOGY HINDI LITERATURE
D

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