EL Uc Tu S.No I Semester Mode ICSE institute of Advanced Studies in Education Deemed University Seed Node: 7] Gandhi Vidya Mandir, Sardarshahr, Rajasthan - 331401, India Form received on university = | Do not leave any column blank. Form should be complete inal respects otherwise it will be rejected. Cost of form Re. 50k exrowenrno. [rals[el/ 0 1/ CL1/ NAME OF CENTRE I ene ‘ADDRESS OF I cou pea CENTRE Devetpiaretale st tne yn nee I Photgach at aso be ‘Eran the Core Hed CENTRE CODE MOBILE NO. COURSE NAME I COURSE CODE sem (28) [_]/ YR (2-4) APPEARING IN, EXAM CHANGE OF CENTRE we CE] cee EF] ve TT] Noc (As entered in seconday / SarioySeconsayorequvetertExamnaton Cenfcate) NAME OF I CANDIDATE, NAME OF MOTHER NAME OF FATHER / HUSBAND PERMANENT ADDRESS EMAILID... MAILING ‘ADDRESS STD CODE... (OWN E-MAIL ID . ‘STD CODE PH... os. SUBJECTS / PAPERS IN WHICH THE CANDIDATE IS APPEARING (Clearly mention name of Paper with Subject code) SUBJECT CODE NAME OF SUBJECT / PAPER 1 2 3 4 5 6 8 7 9 FOR OFFICE USE RECEIPT SECTION Accepted ADMISSION SECTION Rejected ACCOUNTS SECTION No. of Documents received. Reasons for rejection as per S.N Remarks Signature of AR/Addl. Registrar Signature of COE | FullName of eating AssistantDETAILS OF PREVIOUS EXAMINATIONS APPEARED (Enclose photocopylies) of previous mark card(s) / tabulated result sheets (TR) duly attested by gazetted officer / notarized, verified by centre head and self attested by the student) Seat) (paper c Cee Bead Ist Sem/Y¥r lind Sem /¥r ed Sem Yr Ivth Sem 1 ve| ih Ser vith Sem, wilth Sem vVilith Sem 4% Jan-June / July-Dec (Semester Mod) Jan-Doc /July-June (Yearly Mode) 5.No.| Particulars of Fee “AmOUPt lye Payoo Draft No. Dated + | Cours Fee Re. (i figures. Rs. (in words) 2 _| Reegiotration Fee 00 Bank & Branch Semester Examination Fee (Ra 400) 2 ds ‘ 000) In Favour of REGISTRAR, |ASE UNIVERSITY - A/c C¢ Iomanonensnnns sume 4 _ | Yearly Examination Foo (Re 4,200) (hy Cone Coan Pee A aden eh So 5 _| Study Gente Taner Fee (Re 00) fovea moses aris oe a Gober ose ce a ko cespayretc ome in Besa eo lf nt i ai B | eee mon Scopalnes ict fa permet oie abd enous hep henmenui ar hr el ch ib pet op (TOTAL AMOUNT IN RS.) otro) kr mich prt fade oye ree kati tb me. DECLARATION BY THE STUDENT [have read ard understood, the rules and regulations athe Unversity and Ifullthe eigibity conditions as lac down in the prospectus, Ihave furnished necessary informationdocuments) correctly. | shal submitany other documents) that may berequiredin future. lunderstandthat my candidatureisliable tobe canceled by the Institute of Advanced Studies in Education Deemed Univesity the information | document(s) submited hecevithis found incorrect misleading /forged stany point cf tme. Further, the Lniversity hs fll authority to take appropriate action which shall be acceptable to me including cancellation of the Degree / diploma and | or {oreture ofthe fees submitted, The programme being undertaken by me i for academic purpose only | understand thatthe University has the right toad / delete / change the sya, course, ules anc regulations as and when required without notice. have read, understood the notms ofthe University. FEES once paié wilnotbe refunded adjusted. The fees, paid by mes only forthe various programmes under distance education mode, Signature ofthe candidate nfl No. OF DOCUMENTS (opMyyy) ENCLOSED BY ME Dated VERIFICATION BY THE CENTRE HEAD Certified that the documents produced and verified by the candidate, as given above, have been checked with the original eligibty documents, rewverified, “stamped and dated by the undersigned and are correct. | am responsible for any diserepancies in the detaile given above and the consequences thereby. “Tota No, of documents enclose by me Details ofmerk cards itRatechea | 1 | 2] 3] 4] 5|6 | 7 | 8 | semesterrvear Full ame of Signatory, Dated (oDmMYYYY) SIGNATURE OF CENTRE HEAD WITH SEAL Form Incomplete due to the following reasons: (11. Form not signed and dated by the candidate verified & stamped 1] 9. Study Centre name & code not mentioned / does not match by the centre head allocated code . 5.2. Photograph of candidate not affixed / clear / coloured | Self [1] 10. Change of Study Centre, Transfer Fee and NOC notenclosed. attested | vorified by the Study Centr. Fi 11. Streamnot allatted to the Study Centre C13. Semester / Year wrongly filled by the candidate, as per previous sdafter last date, requisite late fee not enclosed. records. lity documents received after the last date therefore eligible for next session, 14.Re-ragistration / Examination / Course F notenciosed. (14. Documents not Selfattested /verfied by Study Centre/notrised. 515. TR& Mark Card copies not enclosed. 6, Permanent address /Mailing address /Esnailid/ Phone No. not Late Foo mentioned. 7. Enrolment No. does not match / Course Code wrongly 15.Thestudent appearing forfinal sem year butall previous year mentioned. mark ard copies notenclosed, 8. Application form is of old format / Photocopied / illegible not _() 16.Cenire not permitted toaccept re-egistation form. filled in capital letters or Blue ink. CO 17.0thers.