BAGWAN\M S Bagwan DN: CN = BAGWAN\M S Bagwan

Digitally signed by BAGWAN\M S Bagwan Reason: I am the author of this document Date: 2011.02.23 12:09:49 +05'30'

BHARATI VIDYAPEETH DEEMED UNIVERSITY, PUNE

CET online Application Form-2014-15 For Admission to

FORM NO

6038
EXAM CODE

MBBS/BDS/BAMS/BHMS 2014
Read Instructions given at the end of the second page carefully. Candidate Name : PREETI SEMWAL

11

Gender: Female

Date of Birth: 23 Nov 1995

Category: Open

Address of Communication:

A-7,70-71,SECTOR-17, ROHINI,DELHI-110089, City :- NEW DELHI, State:- Delhi, Pin:- 110089

Phone No: 011-27859728 E-Mail Mobile: 9555031042

: SUMITGHILDIYAL20@GMAIL.COM

10th Marks Details Passing Year Marks Obtained Outof

2011

HSC/12th Marks Details 2013 500 352

MARKS OBTAINED

Sign Candidate Signature

8.6 10

Demand Draft Details DD No:-770037 Amount:-2200

CHOICE OF CENTER

Bank Name:-State Bank of India

NAME & ADDRESS OF PARENT/GUARDIAN Parent Name: B. P. Semwal

Address:

A-7,70-71,SECTOR-17, ROHINI,DELHI-110089, City :- NEW DELHI, State :- Delhi, Pin:- 110089

Phone No:

New Delhi

Mobile:

E-Mail

LAST SCHOOL/COLLEGE DETAILS

SCHOOL/COLLEGE:

MOUNT ABU PUBLIC SCHOOL

SECTOR-5, ROHINI , NEW DELHI, State:- Delhi

ADDRESS:

PHONE NO:

01127041516

Stream at HSC/12th level

BIOLOGY,CHEMISTRY,PHYSICS,ENGLISH CORE,MATHEMATICS

Declaration - I A. I hereby declare that the information filled online in this form is true and Complete to the best of my knowledge. I am aware that if any information herein is found to be incorrect or incomplete, my application form will be rejected / admission will be cancelled. B. I have studied and understood the Rules Of Admission Procedure and Fee Structure and agree to abide by these rules. C. I have read and understood all the provisions contained in the Prospectus and hereby agree to abide by these provisions. D. I am aware that any legal matters arising out of the total admission process through All India Common Entrance Test of Bharati Vidyapeeth University, Pune 30 will be subject to courts of Pune jurisdiction Maharashtra. Date: Name of the Candidate: Declaration II A. I, the parent / guardian of (applicant) hereby declare that I am aware of the financial obligations of admitting my child / ward to the colleges of Bharati Vidyapeeth University. I also endorse the declaration made above by my child/ward. B. I agree to pay the Tuition fee and Other Fees to the Institution as fixed from time to time as per the rules. C. I have read all the rules governing the process of Common Entrance Test, Counseling, Admission and Fee Structure of CET and agree to abide by the rules. Place: Date: Signature of the parent / guardian Name of parent / guardian: INSTRUCTION
Attest the Photograph (Attestation from any gazetted officer).
B. P. Semwal

Signature of the Candidate

PREETI SEMWAL

IF YOU HAVE MADE PAYMENT THROUGH PAYMENT GATEWAY BRING THIS FORM AT EXAM CENTER. AND INGNORE 3RD PAGE.

NOTE
PAYMENT THROUGH DEMAND DRAFT Send the form along with Demand Draft to

Bharati Vidyapeeth University, 2nd floor, CET Online Department, Bharati Bhavan ,LBS Road, Pune 411 030, Maharastra

This Page to be pasted on a 10 inch X 12 inch size envelop

Bharati Vidyapeeth Deemed University

Social Transformation through Dynamic Education

CET-Online application form for::

MBBS/BDS/BAMS/BHMS 2014

To, CET-Online Registration Department, 2nd Floor, Bharati VidyaPeeth University L.B.S. Road, Navi Peth, Pune, Maharashtra. Pin:: 411030 From:
PREETI SEMWAL

Form No:

6038

A-7,70-71,SECTOR-17, ROHINI,DELHI-110089, City :- NEW DELHI, State:- Delhi, Pin:- 110089