Received on ....................................................

Signature of Receiver .................................

PANJAB UNIVERSITY, CHANDIGARH

ADMISSION FORM FOR ONGOING CLASSES
(Semester 3rd, 5th, 7th & 9th only)
Academic Session 2018-19

Class _____________________________ Affix self-

Panjab University Registration No. _____________________________________________ attested recent
Photograph of
1. Name of the Candidate _____________________________________________ 3.5 cm x 4.5 cm
2. Father’s Name _____________________________________________
3. Mother’s Name _____________________________________________
4. Guardian’s Name _____________________________________________
5. Date of Birth _____________________________________________
6. Address for Correspondence 7. Permanent Address
_________________________________ ___________________________________
_________________________________ ___________________________________
_________________________________ ___________________________________
Mobile No. Mobile No.
_________________________________ ___________________________________
8. E-mail ID _________________________________________________________________________
9. Do you belong to Economically Weaker Section? Yes / No
10. Annual Family Income from all sources ___________________________________
11. Aadhaar Card No. (Optional) ___________________________________________
12. Blood Group ________________________
13. Previous Semester / Year Examination Details
Semester/Year Marks Obtained Maximum Marks %age Year Examination Roll No.
II
III
IV
V
VI
VII
VIII
IX

Place: ________________
Dated ________________
(Full signature of the candidate)