17/02/2017

ApplicationforPET

REGISTRATIONNO: BHU01076649462 PAYMENTID: BHUP510766490815J

CourseName: (462)M.A.Sociology
:
CandidateName: PANKAJKUMARMAURYA
:
Father'sName: SHESHDHARMAURYA
:
Mother'sName: GEETADEVI
:
Father's/Mother'sMobile 8806127836
Number:
/:
DateofBirth: 24.May.1999
`:

Sex/ : MALE Category/: OBC

BloodGroup: A+ Employee'sWard: NO
:

:
PhysicallyChallenged: NO SportsSeat: NO
: :

Nationality/: Indian Doyoubelongto"BHUStudent YES

Category"?:
Religion/: HINDU ..

AadhaarCardNo/ 557280126783
:

AddressForCorrespondence PermanentAddress
Name: PANKAJKUMARMAURYA Guardian'sName(If SHESHDHARMAURYA
Applicable)

Address(): VILLNARTHUA
Address(): VILLNARTHUA
POSTAURAI
POSTAURAI

District(): BHADOHI
District(): BHADOHI
State(): UttarPradesh
State(): UttarPradesh

Pin( ): 221301 Pin( ): 221301

Ph.No.withSTDCode
Ph.No.withSTDCode
FaxNo.
MobileNo.() 7348593219
MobileNo.() 7348593219
Email adinr1709@gmail.com

DistanceofyourResidencefrom 2099 AnnualIncomeofyour Lessthan2,00,000

BHU. Parents/GuardiansinRs.

TestCenterPreference
Preference01 VARANASI Preference04 GORAKHPUR
Preference02 RGSCMIRZAPUR Preference05 DELHI
Preference03 ALLAHABAD

SignatureUploadedby
thecandidate

ItisherebyconfirmedthatIhavecarefullyreadtheconcernedInformationBulletinavailableontheBHU'sEntranceTestPortal(www.bhuonline.in)beforefillinguptheApplicationForm.
IherebysolemnlyaffirmthattheinformationfurnishedinthisOnlineApplicationFormistrueandcorrecttothebestofmylnowledgeandbeliefandnomaterialinformationhasbeen
concealedorsuppressed.Ifanyinformationisfoundtobefalse,incorrectormisleading,theBanarasHinduUniversityshallhavetheauthoritytocancelmycandidature/admission
withoutanyfurtherenquiryornotice.
Iundertakethat,ifadmitted,IshallabidebytheUGCRegulationsonCurbingtheMenaceofRagging,2009,OrdinancesgoverningthedisciplineofstudentsofbanarasHinduUniversity
andsuchotherRules,OrdinancesandRegulationsthatmaybeframedbytheBanarasHinduUniversity/UGCfromtimetotime.
IfurtherundertakethatthepreferencefortheTestcenter,Courses,DomicileandthecategoriestowhichIbelongasindicatedbymeintheonlineapplicationformshallbeirrevocable.

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