Estd:1991 Cell: 09849161157

Ph: 0877-2232359
DR. AMBEDKAR LAW COLLEGE, TIRUPATI
(Afliated to Sri Venkateswara University, Tirupati)
Recognised by B!", #ew $el%i & 'ovt o( A)S!*+, *yderabad
,-./.0123,2A04, 55!%eruvu, Renigunta Road, Tirupati, A), "ndia
Application for admiion into ! "#ar $ % "#ar
L.L.B$B.B.A,LL.B %"#ar int#&rat#d co'r#. ()**+*(
Mana&#m#nt $ La,c#t -o'ta
, #a6e o( t%e !andidate
(!apitals as per SS!)
0 3at%er7s 2 'uardian7s
#a6e
/ P#rman#nt Addr# Addr# for Comm'nication
!ell8 )%8
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Birt.
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Ditrict 0tat# 3ationali
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: 3
; Local Ar#a of t.# Candidat#4 (Tick in t%e appropriate bo<)
Rayalasee6a And%ra Telengana =t%er State student
SVU S5U AU #U =U 5U
> M#ntion t.# Cat#&or" to ,.ic. "o' 5#lon&4 (Tick in t%e appropriate bo<)
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@ Ann'al Incom# of t.# par#nt $
G'ardian
6i& Word
A D#tail of 7'alif"in&
#2amination4
3am# of t.#
E2amination4
8#ar of Pain&4
D#&r##$Int#r$9( Total Mar: A&&r#&at#
("ncluding t%e languages)
Total :arks8
:arks Scored8
A&&r#&at# P#rc#nta&#4
- ;#ri<cation of C#rti<cat# (Tick in Appropriate
bo<)
;#ri<#d 5"4
BA?!+T*T RA#5 !AR$ T! & !! $egree2"nter :arks
State6ents
!aste certiCcate 2 "nco6e !ertiCcate :igration certiCcate
P=OTO
#!!2#SS2Sports2)*2+<ser
D#claration 5" t.# Candidat#
" declare t%at t%e in(or6ation given above is true to
t%e best o( 6y knowledge and belie( and " a6 aware
t%at i( all or any part o( t%e in(or6ation given above
is (ound incorrect, 6y application is liable (or
reDection and ad6ission i( 6ade on t%e basis o(
above in(or6ation stands cancelled
Tirupati
$ate8 0i&nat'r# of t.#
candidat#.
D#claration 5" t.# par#nt $ &'ardian
" certi(y t%at t%e in(or6ation (urnis%ed above 6y
son2 daug%ter 2 ward is correct and " s%all be
responsible (or %is2%er good be%avior as per t%e
rules in (orce (ro6 ti6e to ti6e during t%e period o(
t%e study
Tirupati
$ate8 0i&nat'r# of t.#
par#nt$&'ardian
Pro>iionall" Admitt#d $ 3ot Admitt#d
Principal Con>#n#r,
La,c#t
Student Profile & Adission !e"l#r#tion $or
%&o 'e filled in '( the student )ith their o)n h#nd )ritin* onl(+
Name :
Mothers name:
Fathers name :
D. No : Photo
Street /lane/village:
Mandal :
District :
State :
Cell.No :
Phone No :
Talents :
!e"l#r#tion
Sir,
IS/o..the
Candidate seeking admission into 1
st
year L.L.B (3 YDC/5YDC/B.B.A,LL.B 5YDC) degree
course during the academic year !11"!1 at Dr. Am#edkar La$ Co%%ege, &iru'ati do
here#y dec%are(
1. &hat ) $i%% a#ide #y the ru%es and regu%ations o* the co%%ege and maintain
disci'%ine and attend the c%asses regu%ar%y.
. &hat ) $i%% 'ay the co%%ege *ee as 'rescri#ed #y the uni+ersity/co%%ege at the time
o* admission and at the #eginning o* the su#se,uent academic years.
3. &hat i* ) discontinue the course, ) $i%% 'ay the #a%ance o* co%%ege *ee *or the
remaining 'eriod o* the course.
-. &hat ) $i%% su#mit the *i%%ed"in"a''%ication o* 'ost"metric scho%arshi' $ithin 1! days
*rom the commencement o* the course a%ong $ith the necessary certi*icates. )
$i%% not re,uest *or origina% certi*icates during my 'eriod o* study. (As the same
may #e ins'ected at any time #y the authorities concerned) (*or scho%arshi'
students on%y)
5. ) $i%% a''ear *or the uni+ersity e.aminations as 'er the ru%es and regu%ations o*
the uni+ersity.
/. &hat ) am not an em'%oyee o* any 0o+ernment 1er+ice, either Centra% 0o+t.
/1tate 0o+t. /2.1. 3.1. etc.

Tirupati Signature of the Student
Date:
Email:-
FEE FIXED FOR !"!#EE"T / $!%&ET SE!TS
), 44444444444444444444444444, 1/5 444444444444444444
6oined in Dr. Am#edkar La$ Co%%ege, &iru'ati in 44 years LL.B / B.L
/B.B.A,LL.B 5YDC Course during academic years !11"1 #atch. ) kno$
that ) ha+e *i.ed amount o* 7s. 444444444/" 'er year and ) $i%% 'ay
regu%ar%y.
) $i%% a#ide the ru%es o* the co%%ege and uni+ersity, i* a%% or any 'art o* the
in*ormation gi+en a#o+e is *ound incorrect, my a''%ication is %ia#%e *or
re6ection. and admission i* made on the #asis o* a#o+e in*ormation stands
cance%%ed.
&iru'ati.
1ignature o* the candidate.
Partic'lar for ID card
, #a6e 8 .
0 Registration #u6ber8 . =33"!+ )UR)=S+
/ Address8 .
9 $ate o( Birt%8 .
; Blood 'roup8 .
Recent
passport siEe
p%oto
> e6ail."$ .
@ :obile #u6ber8 .
- !ourse $etails8 .
,4 $uration o( t%e course.
,, Fear o( Doining8 .
,0 Signature o( t%e student . GWit.in t.# Bo2?

Student Profile & Edu"#tion#l ,u#lifi"#tion
%&o 'e filled in '( the student )ith their o)n h#nd )ritin* onl(+
1- .#e :
2- Sur .#e %E/0#nsion+:-
3- 1other2s n#e :
4- $#ther2s n#e :
5- !#te of 3irth : A*e:- Photo
6- C#ste :- Su' C#ste:-
7- 1other &on*ue:-
8- Address :
!-.o:-
Street 4l#ne45ill#*e:
1#nd#l :
!istri"t :
St#te :
Cell-.o & Phone .o- :
9- D#tail of Ed'cational -'ali<cation of t.#
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