HIMACHAL PRADESH UNIVERSITY, SHIMLA -171005.

APPLICATION FORM FOR ENTRANCE TEST FOR ADMISSION TO B.Tech (CSE/IT) COURSE FOR
THE SESSION 2019-2020

1. Name of the Course : B.Tech (Civil,CSE,IT,Electrical,ECE)

2. Name : HARSH DHIMAN

3. Father's Name : Shyam lal

4. Mother's Name : Simran

5. Examination Center for Entrance Test : SHIMLA

6. Address for Correspondence (IN CAPITAL LETTERS) :

HARI NIWAS DINGLE ESTATE NEAR COMBLEY BANK SHIMLA

7. Mobile No. 9816344857

8. Permanent Home Address (IN CAPITAL LETTERS) :

HARI NIWAS DINGLE ESTATE NEAR COMBLEY BANK SHIMLA

9. Telephone No.

10. Email-Id : harshdhimanznet@gmail.com 11 Aadhaar No. : 624582979930

.

12. Date of Birth : 16 Feb 2001 Age as on 1st July of this year : 18 yrs. 5 Months

13. High School Marksheet No.: 9.4 CGPA

14. Nationality : Indian 15. Sex : Male

16. Are you Bonafide resident of Himachal Pradesh? : Yes

17. Are you a Singal girl child ?: No 18. Are you physically challenged?: No

19. Are you Ward of HPU Employee? : No 20. Do you belong to J&K Domicile? : No

21. Economically Weaker Section : No

22. 12 School Located in : HP

23. Board of 12 Exam : Other

24. Your Category : Scheduled Caste

25. Details of Fee Deposited Amount : Rs. Dated : 25/04/2019

1000.00
26. Academic Qualifications :

Result Examination Name of the Passing Credits/Marks Maximum Marks Credits/ Exam
Status Passed Board/University Year Obtained (not for the % Marks Roll No.
candidate with
CGPA)
Passed Matric or CBSE 2017 9.40 0.00 89.30 2303808
Equivalent
Awaited +2 or
Equivalent

27. Were you ever disqualified/suspended by the University or any other institution from No
attending classes or appearing in any exam ? If yes, give Details :

Details :

Declaration by the Candidate

I declare that the entries made by me above are correct to the best of my knowledge. I am conscious that if
any of the entries are found to be incorrect, my admission is liable to be cancelled. I have read carefully the
Handbook of Information and I undertake to abide by the rules of the University. I have gone through the rules
and regulations of the University and I hereby solemnly affirm that I will not indulge in any kind of
ragging/indiscipline and if I am found guilty of any offences, I will have no claim against the order of the
rustication/ expulsion /Cancellation of my admission from the University.

Date : Student Signature