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Name​* Father's/Mot
(Exactly as Enter Name her's Name​* Enter Father
per Matric (Exactly as Name
Certificate) per Matric
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B.Pharma ( Type
Allo.)
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Ayur) B.Tech
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her -- YES
you NO ​*
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ar in
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tion
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a
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Himachal Pradesh For m

Technical University, No.
 Hamirpur-177001
70
05
86
Reappear Exam For Summer Term Examnination -July
2016

Personal Details

Name SAURAV
(Exactly as per Matric Certificate) KAUSHAL
Father's/Mother's Name BALBIR SINGH
(Exactly as per Matric Certificate)
University Roll No 20BTD5020093

Registration No. 20BTD5020093

(Issued by the University)
Sex MALE

Mobile No. 7807254485

SAURAVKAUSH
​Email ID AL7807@GMAIL.
COM

Class B.T Sem I

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Code 002 lt of ULT-
Last AWA
Exami ITED
natio
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​Whether you want to
appear in the
Practical(s)
Examination ? ​ NO

​Have you been

disqualified by this
University/Board form
appearing in any
examination?​ NO

N Y R
a e o
m a ll
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o o
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Contact Details
Permanent Address Correspondence
Address
MIG-193 MIG-193
SECTOR-4,PARWANOO SECTOR-4,PARWANOO
,TEHSIL -NALGARH ,TEHSIL -NALGARH
DISTT.-SOLAN (H.P) DISTT.-SOLAN (H.P)
173220 173220

Fees Details
Transaction Fees : Date :
Number : 1500. 7/4/2016
290907758166
00
1860

DECLARATION
I solemnly declare that the above
particulars have been filled by me and
are correct to the best of my knowlegde
and belief and in any case of any
discrepancy found therein subsequently
at anyb stage I shall be responsible for
the consequences arising out there from
and liable to disqualify by the University.
 Date: ​ 06/07/2016
C
a
n
d
i
d
a
t
e
'
s
S
i
g
n
a
t
u
r
e

Certificate No-I
Certified that:-
i. He/She has
attended regularly
the prescribed
courses for the
relevant semester
and attended not
less than 75% of
lectures including
tutorials, Drawing
work, Practical
work in
laboratories/works
hop and survey
 field in each
subject of the
examination and
has fulfilled all
conditions lay down
in the ordinance in
force
ii. He/ She have passed the
examination which makes
him/her eligible for
admission to this course
as provided in the
ordinance.
iii. He/ She have worked
diligently throughout the
period and have obtained
pass marks in all the
session and his/her conduct
and behavior has been
satisfactory.
iv. He/ She has satisfied me
by production of authentic
documents that the
particulars filled in by
him/her overleaf are
correct and has signed this
Admission form in my
presence and has paid the
Admission Fee.
v. He/ She have passed all the
lower semester
examinations.
vi. He/She is appearing in this
examination simultaneously
along with

semester examination.
vii. He/ She has passed ​
Semester Examination and
Passed/Re appear.
(Strike off Column V or
VI which is not
applicable)
I further certify that the
candidate has been on
Roll of this College
throughout the semester
period preceding the
examination and is
eligible to appear in the
examination, under the
Rules.

Date:-
 Principal
Important Note: - Before
attestation, the authority
may kindly ensure that
the entire particulars
filled by the candidate
have been checked and
verified an their end,
particularly in column 5
& 7 overlies.

Certificate No-II
(For Late College/Re-appear
candidates)
Certified that:-
i. The candidate has
completed the prescribed
course of lectures in the
month & Session year
20____ and is eligible to
appear as ex-student having
fulfilled the conditions laid
down under the ordinance.
He/She is a good moral
character, and the
statement given by him/her
overlief is corrent and
he/she has signed this
Admission Form in my
presence.
ii. The candidate appeared as
college candidate last
month
of​
​ and placed under
Re-appear in the Paper(s)

(Strike off Column which

is not applicable)

Date:-​
​
Principal
Particulars and eligibility
checked, Discrepancy if any,
entered at page ​
​ in the
Discrepancy Register.
Eligible/Not
Eligible
1. ​ ​ 2.
​
Signature of the Officials
concerned
Assistant Supdt.
(Exams)
 HIMACHAL PRADESH
TECHNICAL
UNIVERSITY,
HAMIRPUR
Sr. No.​

PROVISIONAL SUBJECT TO
ELIGIBILITY
Roll No.​
​
(TO BE ASSIGNED BY THE OFFICE)
Note:- (The Candidate will
be admitted to the
Examination Hall on
production and delivery of
this Roll No. slip.)
(To be filled by the
candidate)
Admit (Name of the
PAS Candidate)
SPO
RT
SIZ Son/Daughter of
E
PHO
TOG
RAP in College of
H
DU
LY
ATT
Engg./Pharmacy/M.B.A/
EST M.C.A
ED
Semester Examination

to be held in​
20​ ​on the dates and
Centre as given in the
Date Sheet

Centre of Examination

Controller of
Examination
Signature of the
Candidate
HIMACHAL PRADESH
 TECHNICAL UNIVERSITY

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