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Admission Form

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34 views

Admission Form

Uploaded by

manish010112211
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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Maa Shakumbhari University, Saharanpur, Uttar Pradesh

माँ शाकुम्भरी िवश्विवद्यालय, सहारनपुर, उत्तर प्रदे श


GRADUATION : REGULAR REGISTRATION
FORM
PERSONAL DETAILS [ व्यिक्तगत िववरण ] Print Time : 05-11-2024 11:35:57

Roll Number: 210665106004 Registration Number : 30044876


Student Name: ABHAY TYAGI Student Name (Hindi): Abhay tyagi
SANDEEP
Father Name Father Name (Hindi): Sandeep tyagi
TYAGI
Mother Name RAKHI TYAGI Mother Name (Hindi): Rakhi tyagi
Physical Handicap: NONE Gender: MALE
Mobile Number: 7453992306 Date of Birth 07/09/2002
Domicile State Uttar Pradesh Domicile Certificate No.:
Caste/Category: GENERAL(UR) Caste/Category Certificate No.:
Reservation Category Certificate
Reservation Category: NONE
No.:
Other Category: NONE Income Group: NONE
Religion: OTHERS E-Mail Address: [email protected]
Is Minority: Minority Certificate No:
Marital Status OTHERS Nationality
Sports Quota Opted: EWS Status: NO
Aadhar Number: Aadhar Enrollment Address:
Medium of Instructions /
Medium of Examination:
Communications:
Academic Bank Of Credit
Migration Certificate No.:
ID.:
University Claim: NONE N.C.C. Claim: NONE
N.S.S. Claim: NONE Scouting Claim: NONE
139-DISHA BHARTI COLLEGE OF MANAGEMENT & EDUCATION, OPP. D.P.S. DELHI ROAD,
Admitted College:
SHARANPUR
Admitted Course: 217-B.C.A ( OLD COURSE )
Selected Subjects: 280-COMPUTER APPLICATION
ADDRESS DETAILS
CORRESPONDENCE ADDRESS DETAILS
Address VILL-KISHANPUR, POST-JARODA PANDA, SAHARANPUR State Uttar Pradesh
District Saharanpur Pin Code 247453
PERMANENT ADDRESS DETAILS
Address VILL-KISHANPUR, POST-JARODA PANDA, SAHARANPUR State UTTAR PRADESH
District SAHARANPUR Pin Code 247453
QUALIFICATION DETAILS
PASSING MARKSHEET MAX MARKS PER(%)/GRADE
EXAMINATION BOARD / UNIVERSITY ROLL SUBJECT
YEAR NO MARKS OBTAINED /POINTS
HIGH SCHOOL
OR
EQUIVALENT
INTERMEDIATE
OR
EQUIVALENT
10th Subject(Home Science,Maths): OTHERS
COURSE APPLIED & PAYMENTS DETAILS
Intermediate Stream
Declaration
I declare that I have never been convicted for any criminal act and that there is no case pending against me in the court of law. I also declare
that I have never been caught using Unfair Means or any Disciplinary action has been taken against me. If I was charged for using Unfair
Means, the punitive duration is over and charges have been cleared.
I have read carefully and have understood all rules as mentioned in the University Rules and Admission Brochure.
Furthermore I also declare that if my application is found to contain incorrect/false information regarding my Name, Birth Date, Gender,
Religion, Domicile, Weightage, Caste, Horizontal Reservation, Marks obtained or any other field, my application is liable to get cancelled,
and I will have no objection in getting disqualified for admission to the concerned course/college.
_________________________________ _________________________________
Signature of the Parent/Gaurdian Signature of Candidate
Date: ___________________ Date: ___________________

NOTE: Mark the number of documents(Photocopy) attached by the Candidate during form submission to the college, and also carry all
documents in Original.

Application Form (Printout) Fee Receipt (Printout)

Xth Marsheet Xth Certificate

XII th Marsheet Under Graduate Marksheet

Recent Passport Sized Photograph Scanned Signature

Domicile (for other state) Certificate for Kashmiri Resident

Certificate for Horz./Reservation Certificate Certificate for Vert./Caste Category

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