CHAUDHARY CHARAN SINGH UNIVERSITY, MEERUT

Under-Graduate (UG) Admission Registration Form

SESSION 2017 - 2018
Registration # 17G0164201 Reg. Date : 10 July, 2017 11:40 AM

1. Candidate Name : SAGAR LUSKARY

2. Father's Name : JAI KUMAR
3. Mother's Name : NIRMALA
4. Date of Birth : 04-Jun-2000 5. Gender : MALE
6. Caste/Category : O.B.C. 7. Reservation : Not Applicable
8. Caste Certificate #: 9. Income Grp : Less than 1 Lac per
annum
10. Domicile : Uttar Pradesh 11. Religion : Hindu
12. Domicile Cert. #: 13. Is Minority : NO
14. Nationality : INDIAN 15. Other Cat. : Not Applicable

16. Address for Correspondance : 17. Permanent Address :

VPO SHABGA TEH BARAUT THANA CHHAPURLAI VPO SHABGA TEH BARAUT THANA CHHAPURLAI
Baghpat Baghpat
Uttar Pradesh
PIN Code : 250617

L Uttar Pradesh
PIN Code : 250617
NA
18. Mobile : 9634773957 19. Email : sagarlashkari46@gmail.com

20. Weightages Claimed :

Weightage Add %

21. Academic Record :

Examination Year Max Obt. Stream Subjects Board %
Highschool 2014 500 323 N/a HINDI ENG MATH SST Other Foreign Board 64.6
FI

SCIENCE

Intermediate/Pol 2017 500 404 PCM Other Foreign Board 80.8

22. College Application Details :

Sr. College Degree Subject/Group
1 [623] GAYTARI DEVI COLLEGE OF EDUCATION MALAKP B.C.A. Computer Application

Printed: Thursday, August 17, 2017 11:46 AM Page: 1/2

 CHAUDHARY CHARAN SINGH UNIVERSITY, MEERUT
Under-Graduate (UG) Admission Registration Form
SESSION 2017 - 2018
Registration # 17G0164201 Reg. Date : 10 July, 2017 11:40 AM

23. 10th Marksheet #: 1379983 24. 10th Roll No. : 5128057

25. 12th Marksheet #: 26. 12th Roll No. : 1720527

27. 10th Passing Year: 2014 28. 12th Passing Year :
29. AADHAAR No.: 701545259731 30. AADHAAR Enroll # :
31. Payment Details: Paid Rs.100.00 on 10/7/2017 PayU# 6270776736 Bank Ref: SBIB - IGABPYVQZ5
32. Other Qualifications :

L
NA
NOTE: Mark the number of documents ( Photocopy/Xerox) attached by the Candidate during form submission to the college

Xth Marksheet Xth Certificate

XIIth Marksheet Last Exam Passed Marksheet
Recent Passport Sized Photograph Scanned Signature
Domicile (for other state) Certificate for Kashmiri Resident
FI

Certificate for Horz./Reservation Category Certificate for Vert./Caste Category

Declaration

I declare that I have never been convicted for any criminal act and that there is no case pending against me in
the court of law. I also declare that I have never been caught using Unfair Means or any Disciplinary action
has been taken against me. If I was charged for using Unfair Means, the punitive duration is over and charges
have been cleared.

I have read carefully and have understood all rules as mentioned in the University Rules and Admission
Brochure.

Furthermore I also declare that if my application is found to contain incorrect/false information regarding my
Name, Birth Date, Gender, Religion, Domicile, Weightage, Caste, Horizontal Reservation, Marks obtained or
any other field, my application is liable to get cancelled, and I will have no objection in getting disqualified for
admission to the concerned course/college.

Signature of Parent/Guardian Signature of Candidate

Date: Date:

Printed: Thursday, August 17, 2017 11:46 AM Page: 2/2