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SHRI LAL BAHADUR SHASTRI RASHTRIYA SANSKRIT VIDYAPEETHA,N.DELHI

(DEEMED UNIVERSITY OF MHRD, GOVT OF INDIA u/s 3 OF UGC ACT 1956)

APPLICATION FORM
 Please read the guidelines carefully before filling up the Application Form
 Please use Blue Ball point pen in the boxes using English CAPITAL LETTERS or English Numerals.
 Write in CAPITAL LETTERS only within box. Leave blank between words as shown in the example below:

1. Application For:
Please Enter Course Name

2. Exam Centre : Affix Recent Passport

Shri Lal Bahadur Shastri Rashtriya Sanskrit Vidyapetha
Size Photograph

3. Name of the Candidate

(As in Matriculation Certificate):
Applicant Signature

SIGNATURE OF THE APPLICANT

4. Father Name (As in Matriculation Certificate):

5. Mother Name (As in Matriculation Certificate):

6. Date of 7. Age as 8. Gender Male/ Female/Other

D D M M Y Y Y Y Years Months Days
Birth: on 01.10.2019

9. Marital Status 10. Religion 11. Nationality

Married/unmarried/others

12. Aadhar No. 13. NAD-ID

14. Kashmiri Migrant: Yes/No 15. Category-I: GEN/SC/ST/OBC/EWS

16. Category – II
i.) Children/War Widow of Armed Personnel (Yes/No): Yes/No
If it is YES, Please Tick mark ()
a. Battle Casualty
b. Physical Casualty

ii.) Vidyapeetha Employee Ward/Spouse (Yes/No): Yes/No

If it is YES, Employee Name Relation with the employee

iv.) SLBSRS Vidyapeetha Student (Yes/No): Yes/No
If it is YES, Course Name Result Passed/Appearing Passing Year

v.) Whether a person with Disability (Yes/No): Yes/ No

If it is YES, Please Tick mark ()
a. Speech & Hearing Impairment
b. Loco-motor Impairment
c. Visual Impairment

vi.) Sports person (Yes/No): Yes/ No vii.) NCC /NSS Cadet: Yes/ No
If it is YES, Please Tick mark () If it is YES, Please Tick mark ()
a. National a. NCC –‘B’ Certificate b. NCC –‘C’ Certificate
b. International c. NSS –Certificate
17. Correspondence Address: (Give space between words)
a) House No: b) Street

c) Locality/
Mohalla

d) Tehsil/
District

e) City f) State

g.) Pincode

18. Permanent Address: (Give space between words)

a) House No: b) Street

c) Locality/
Mohalla

d) Tehsil /
District

e) City f) State

g.) Pincode

19. Contact Details:

a) Mobile
No.

b.) E-mail
20. Educational Qualifications:

% age
Qualification Board/University/College Passing Year Marks Obtained Total Marks
(with Decimal)
10th /
Matriculation or
equivalent
12th/
Intermediate or
equivalent

Graduation or
equivalent

Post-Graduation
or equivalent

21. Stream (Modern/Traditional) Modern/Traditional

22. Only for M.Phil Applicant :

Please Tick mark ()
a. JRF b. NET c. SLET

23. Details of Fee remittance:

(Demand Draft of Rs. 300/- or 450 (with Late fee) for regular courses and Rs.100/- or 150/- for part time courses to be send along
with this form for all applying courses in favour of Registrar, SLBSR Sanskrit Vidyapeetha payable at New Delhi.)

a) Demand Draft No :

b) DD-Date : D D / M M / Y Y Y Y

c) Bank Details :

Declaration and Undertaking:

I hereby declare that I have read and understood the conditions of eligibility for the programme for which I seek admission. To
the best of my knowledge and belief, I fulfil the minimum eligibility criteria and I have provided necessary information and
relevant self-attested documents with this application. I further undertake that I have not concealed or distorted any
information and in the event of any information or self-attested documents are found to be incorrect, false or misleading, my
candidature shall be liable for cancellation by the Vidyapeetha at any time and I shall have no claim of any nature including
refund of any fee paid by me and all the benefits availed by me shall be summarily withdrawn. I do undertake that I have
carefully studied the rules of the Vidyapeetha as mentioned in the Prospectus and I accept them in totality and shall not raise
any dispute over the same. I do understand that the Vidyapeetha can amend or change any rules without advance intimation
and I will be abiding by them.

Place: .........................................

Date...........................................
(SIGNATURE OF THE APPLICANT)