Academic year :
UG Cources
Name of the Student:
Date of Birth : Blood Group : Entrance Exam Taken:
Nationality :
Religion :
Category :
Caste :
Sex :
MF
Mother Tongue :

Parents Information

Father / Guardian Mother
Name
Education Qualification

Occupation

Name of the Company
Designation
Office Name - Address & Phone No
Email-ID
Mobile Number

Permanent Address

Address :
Phone No (with ISD / STD code) :

Address for Correspondence

Address :
Phone No (with ISD / STD code) :

Details of SSLC / X Std.

Name & Address Of Institution :
Board :
Year Of Pass :
State :
Subjects Marks
Total :

Details of PUC / XII

Name & Address Of Institution last studied :
Reg No. :
Board :
Year Of Pass :
State :
Part I (Languages) Marks
Part II (Core Subjects) Marks
Total :

Details of DEGREE / DIPLOMA

Name & Address Of Institutions
University :
Total Percentage :
State :
Name of the Course
Semesters Marks Percentage Year Of Passing
Semester I :
Semester II :
Semester III :
Semester IV :
Semester V :
Semester VI :

Declaration By The Student

  1. I hereby agree to abide by the rules and regulations of the University, the State Government & the college regarding my admission, to be approved based on eligibility criteria and submission of testimonials in original as stipulated by the University.
  2. I agree to abide by all the rules and regulations regarding payment of fees for my course. Payment of fees on time is my/ parent's responsibility and any delay will attract fine as decided by the Management from time to time. I accept that refund of fees is not allowed under any circumstances.
  3. I agree to the rule that deposits of any kind, both at college and hostel , will be refunded only after the completion of the course. I will not request for any refund if I withdraw or vacate the hostel room. I agree that the entire amount shall be forfeited under such situation.
  4. I declare that I shall not indulge in ragging, eve-teasing, smoking, consuming alcohol drug abuse or any other anti-social activity in the college premises, hostel, on educational tours, industrial visits or elsewhere.
  5. I shall abide by the dress code prescribed by the Institution.
  6. I shall abide by the rules and regulations of the Institution in force, which may be amended from time to time by the University/ Management/ State Government/ and/ or any other regulatory authorities. The decision of the Management with respect to any administrative or academic matter shall be final and binding on me at all times.
  7. I shall accept the decision of the authorities in all matters of training, conduct and discipline with no right to question any of them.
I declare that the particulars furnished above are true to the best of my knowledge and belief. I have read and understood the rules and regulations for my admission to course and shall abide by the rules and regulations that shall be binding on me at all times.
Place Date :

Declaration By Parent / Guardian

I hereby declare that my ward does not suffer from any disease/ ailments. I know the financial obligations of my ward and I can afford to pay all the costs and undertake to pay the tuition fees and other fees payable on time to the college as per the rules in force and which may be amended from time to time by the Management. I am aware of the fact that the fee paid to the college for admission will not be refunded in case he/she does not join the course, he/she discontinues the studies, he/she is expelled from the college for any reason. I also stand by the declaration given to the college by my son/ daughter.
I declare that the particulars furnished above are true to the best of my knowledge and belief. I have read and understood the rules and regulations for my ward's admission to course and shall abide by the rules and regulations that shall be binding on me / my ward at all times.
Place Date :