INSTITUTE OF LAW, NIRMA UNIVERSITY

Sarkhej-Gandhinagar Highway, Ahmadabad-382 481, Gujarat, India

Phone: 02717-241900-04/911-15, Fax:02717-241916-17
REGISTRATION FORM

First Year of B.A.,LL.B. (Hons.), B.Com.,LL.B.(Hons.) and BB.A., LL.B. (Hons.)

Programmes
Academic Year 2013-14
FOR OFFICE USE ONLY
Instructions:
(i) Before filling the Application Form, please read instructions
carefully.
(ii) Use black ink/ball pen and CAPITAL LETTERS for filling
this Form.
(iii) Tick ( ) in appropriate box, wherever given.

Admitted in: ___________

Merit No. :____________
Signature of
Admission Officer__________

1) CLAT Seat No.: __________CLAT Rank:__________ Score: _____________

Personal Information
2) First Name

: _________________________________

3) Second Name

: _________________________________

(Fathers Name)

4) Last Name

: _________________________________

(Surname)

5) Full Name

: _________________________________

6) Date of Birth

: _________________________________

Past your latest

passport size
photograph
here
staple)

(DD/MM/YYYY)

7) Sex

Male / Female

Blood Group: ___________

8) Address

: _______________________________________________
________________________________________________
City/Town:______________State/Province: _______________
Country: ______________ Pin/Zip Code: ________________

9) Phone

:__________________________ Fax: _________________

PARENTS/GUARDIANS INFORMATION

Fathers Details:
Name: ________________________________________________
Occupation: ______________________Post/Designation: __________________
Office Address: ___________________________________________________
______________________________________________________________
City: ______________________
District: ___________________
Registration Form UG 2012 - Page 1 of 3

State: ______________________

Country: ______________________

Pin: ______________________

Phone: ______________________

Fax: ______________________

Mobile: ______________________

Email ID: ________________________________________________

Father/Mother/Family Annual Income: ___________________________
Mothers Details:
Name: ____________________________________________________
Occupation: _________________________________________________
Post/Designation: _____________________________________________
Office Address: _______________________________________________
__________________________________________________________
City: ______________________ District: __________________________
State: ______________________Country: _________________________
Pin: ______________________ Phone: __________________________
Fax: ______________________

Mobile: ___________________________

Email ID: _______________________________________________________

Local Guardians Details:
Name: ______________________________________________________
Address: _____________________________________________________
Contact No.:____________________Email:_________________________
10)Nationality

:______________________________________________

11) Any physical or medical challenges, including allergy: ______________________

12) Category

: General / SC / ST / OBC / SEBC

Educational Details:
Examination

Subjects

Name of the Board and

School
(with City/Town Name)

Grade
Year of
/percentage passing

Regular /
Distance /
Corr.

S.S.C/10th

H.S.C. /12th

Registration Form UG 2012 - Page 2 of 3

Declaration by the candidate:

I hereby declare that,
i. The information given by me in my application is true to the best of my knowledge and
belief.
ii I shall abide by all rules and regulations prescribed by Institute of Law, Nirma University
currently in force and as amended from time to time.
III In the event of non-disclosure or distortion of any fact made in the Application Form, I
understand that my admission is liable for cancellation.
Place:
Date:

Signature of the Candidate:

Countersigned by: Parent/Guardian

------------------------------------------------------------------------------------------------------------ADDITIONAL INFORMAITON
1 Medium of Instructions in HSC
Education
2 Academic achievements, if any

1.
2.
3.
4.

Achievement in Co-Curricular/Extra

3 activity if any

1
2
3
4.

Why do you want to join law degree programmes? Please specify reasons.
1.

___________________________________________________________

2.

___________________________________________________________

3.

___________________________________________________________

Registration Form UG 2012 - Page 3 of 3