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CDVL Application Form 2012[1]

CDVL Application Form 2012[1]

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Published by Bajni Srikar
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Categories:Topics, Art & Design
Published by: Bajni Srikar on Feb 22, 2012
Copyright:Attribution Non-commercial

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05/29/2015

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Read the Prospectus and Instructions carefully before filling up the application form.

1. Name of the Student (same as in the SSC / Matriculation certificate) in Capital letters
Mr./Ms./Mrs .........................................................................................................................................................................
2. (a) Father’s Name ............................................................................................................................................................
(b) Mother’s Name
3. (a) Permanent Address: 3 (b) Address for Correspondence
...............................................................................
...........................................................................................................................................................
......................................................................................
............................................................................... ......................................................................................
PIN....................... Phone / Mobile No ................. PIN .................. Phone / Mobile No ................................
Email: ................................................................... Email: ...........................................................................
4. a) Date of Birth .................................................................................................................................................................
Date Month Year
b) Identification Marks 1) ........................................ (2) .................................................................................
c) Nationality .......................................................... Indian / Foreign .............................................................
If Indian, Stateof Domicile:........................................................................................................................................ . . .
If foreign national, name of the Country ........................................................................................................................
d) Sex: Male / Female: e) Marital Status: Married/Unmarried
If married, name of your spouse: ..................................................................................................................................
5. Incase you fail tosecure admission tothe programme you have applied for, indicate a second choice:
.............................................................................................................................................................................................
6. Annual Income of the family: (If SC/ST/PH) ..........................................................................................................................
Specimen Signature of the student (Sign within the box)
Paste here one recent
Passport size photograph
Pin Stamp
Size
Photography
Female Male
APPLICATION FOR ADMISSION TO DISTANCE EDUCATION PROGRAMME 2012
UNIVERSITY OF HYDERABAD
APPLICATION NO.:
COURSE APPLIED FOR CATEGORY
SC ST OBC MINORITY PH
D.D. No. Date Name of the Bank & Place Amount
GENDER
For office use only
7 a) Particulars of past academic record (from Bachelor’s degree onwards)
Examination University
/ College
Month &
Year of
Passing
Subjects
Studied and
Passed
Maximum
Marks
Marks
Obtained
Percentage Division
7 b) Previous and Present Professional Experience
Designation and
nature and job done
Organization / Institution
Total No. of years worked
From
(month & year)
To
(month & year)
DECLARATION BY THE APPLICANT
I hereby declare that all the information furnished by me in this application and the documents I have submitted in support of my
application are true, complete and correct to the best of my knowledge and belief.
Place
Date :
NOTE:
1. If the application is downloaded fromthe website the registration fee is : Rs. 300/-
2. If the application is used fromprinted prospects the registration fee is : NIL
SIGNATUREOFTHECANDIDATE

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