SOUTH DELHI POLYTECHNIC FOR WOMEN

FORMS FOR ADMISSIONS

Session 2012-2013
FOR OFFICE USE ONLY
Course offered:
Registration No:_________________Date:_________________
Last date for Payment of Fees:___________________________
Fees Receipt No:________________ Date:_________________
Hostel Facilities Required:

Please stick one

photograph here
(Do not staple it)
Rest of the three
photographs
should be attached
alongwith form.

YES / NO

Index No.:______________________

List the courses to which admissions are sought.(In order of preference)

1.........................
2 ............................
To,
The Director,
South Delhi Polytechnic For Women,
New Delhi -110024
I, the undersigned hereby apply for admission to the Polytechnic, subject to all the rules and regulations
that may be applicable from time to time.
1 . Full Name (In block letters please). ................. .........
2.

Mother's Name...............................................Mothers Profession........................................

3.

Fathers Name..........................Fathers Profession........................................

4.

Office Address & Tel. No ...............................

5.

Permanent Address & Phone (Both Mobile & Landline)......................... ..........................

.............................................................................................................................................................

6.

Local Address & Phones.........................................................................................

7.

E-mail8. Emergency Number : .....................

9.

Date of Birth10. Nationality................................

11.Particulars of previous and the last Examination appeared / passed.

Last Examination appeard/
passed

Name of School
or College

Year of
appearing
or passing

Marks in percentage or Division

(If Results are awaited-mention)

UNDERTAKING-1

I hereby declare and certify that the particulars given by me above and anywhere else in the forms are
correct and authentic.
I also certify that I have read all the rules and regulations in the Polytechnic and I shall abide by them. I
understand that any payment (including those of fees) will not be refunded by the Polytechnic. This is regardless of whether I
join / do not join, after securing admission or discontinue during a term
...........................................................
Signature of Student

......................................................................
Counter-Signed by Parent/Guardian
UNDERTAKING-2

I______________________________________hereby declare without reservations of any kind, that I

as the responsible parent / guardian of_________________________________will not seek to hold Ashima
Chaudhuri nor anyone employed by her, assisting her or connected in anyway with her Polytechnic, responsible
for / in any mishap,to the student named above. This includes while at / proceeding to / from her Polytechnic in the
Chartered Bus/or otherwise.

Signature of Student

Address................
..
......
.........................................................

..........................................................
Signature of Parent/Guardian

Telephone Numbers....................
KINDLY NOTE:
Please do not enclose originals of any documents. Only attested photostat copies of originals must be submitted. In case of any difficulty
in attestation, you may bring along your originals.Our Admission Officer or / and Admission Incharge, therewith shall attest the Documents.