PUNJABI UNIVERSITY, PATIALA

(Estd. Under Punjab Act No. 35 of 1961)

PERSONAL INFORMATION Name of Student: Course: Stream: Roll No.: Department: Year of Passing: Date of Birth: Gender: Postal Address: City: Telephone No.: Mobile No.: E-mail id: Father's Name: Mother's Name: ACADEMIC RECORD Exam. Matric. 10+2 Diploma Graduation PG Any other Course/Stream Board/Univ. YoP Marks Obtd. Max. Marks PIN:

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Remarks

ACADEMIC ACHIEVEMENTS

SUMMER TRAINING

EXTRA CURRICULAR ACTIVITIES

ANY OTHER INFORMATION

DECLARATION I hereby declare that the particulars given herein are true and complete to the best of my knowledge and belief. Date: Place: Signatures: