SANGAM UNIVERSITY “Established Under Government of Rajasthan Act No. ‘Address: NH.79, Bhilwara Chittor By-Pass, Chittor Road, Bhilwara (Rajasthan) INDIA 311004 C 4 of 2012 Recognised by UCC u/s 2 of 1956) SANGAM" UNIVERSITY £l=|410 ADMISSION APPLICATION FORM 20 - 20 meena ny Enquity No. Date Paste ‘Scholar No. Enrollment No. ‘your Passport size Color Photograph Name of School Course please do not staple Branch OFresh Admission ()Lateral Entry ()Transfer Candidate Signatore wnieneon Name (in English ara feet & Father's Name Mother's Name| Father's occupation ‘Annual income of family Rs. (Caste [SC/ST JOBCISBC/GeniOther Date of Birth Gender|JMale J Female() Transgender [Blood Group] [Religion ‘Aadhar Card Number (12 digits) Permanent Address State city Pin Code STD Code Land line No. Mobile No. (Parents) Correspondence Address State city Pin Code STD Code Land line No. Mobile No.(Candidate) Parent's email ID Candidate's email ID Name of Entrance Exam Entrance Exam Rank Roll No. Year of Passing! Appearing Transport Facility () Yes () No _| Pick-up point Hostel Facility O ves (No | (Single with AG. () Single () Double () Triple ‘Are you applying for scholarship) Yes () NoSANGAM UNIVERSITY (oy ese (Established Under Government of Rajasthan Act No.14 of 2012 Recognised by UGC u/s 210 of 1956) lel ale Educational Qualification Glass | Boers/Universiy Rone, | 22% | HB ],NEIS, | o:age | subject’ Spodatzaton “oth 72th Dipoma UG PG MPR Name and address of School/College last attended - nnn ne nnnnenenenn a Distt: Block PIN PCM" is obtaiss age: _ == DECLARATION oe Son’ Daughler af Shal'Sl, ne ce seokingadmissionto hereby declare that! have carefully read the instructions glver to me and thatthe entries made inthis Application Form are correct tothe best of ‘my knowledge and belie. | understand thatthe decision ofthe University is final an binding in regard to selection for admission. The University shall have the right to take any suitable dscipinary action including expeling me from the University at any time after admission, fam found to be involved in Raging or any direct or indict act of indiscipin orf the documents furnished by mo are feund tobe false or misleading or my antocedants prove that my admission and enrolimentin the University isnot desirable. lagree that althe disputes are subject the jurisction of the courts at Bhiwara, Rajasthan only, The Sangam University shall nt be obliged to refund any fees pad by me, except the refundable amount, ‘and! shall not claim the refund alter due submission offees, Date Signature of Parent/Guardian Signature of Student FOR OFFICE USE ONLY ADMISSION CELL DOCUMENT CHECK LIST As per the documents submitted, candidate is inseidatsry Document aE eligible for provisional admission in Oth wa Ses ere tet) (FD Transfer Certificate cnana 4, Course B)12th wansna gwaesaramany —_||(L) Character Certicaterraran nur iploma wax sie pers tenes) ||C2) Migration Certificaterororat 2.Branch lcraduation nak swe eos senna | Employer NOCioreran Forwarded for document verification (E)Post Grad. ware seerxerx-set tases | |{L) Undertaking ar Resgeatoraea and fee deposition E)Photographs amour sacaura ||) Permanent Address Proofizes) [Gaadhar Card Copy) [RD PAN Card Copy cmon Sign. ofAnison Coote enn © income Certificaterrsines moire Name otAnison oot cco Received Document: (No. _) ,certcaler a es ) | caste Cartes |@ others if any Date: OO0o0o0o0oDl oR Pending Document: (No. __) Forwarded to Admission Committee. OG00000000 Name & Sign. (Rogar Dy, Regist) Ircharge Stor Sacton ACCOUNTS SECTION Payment of fees shall be made through DD/ Cheque! Online Made of Payment | Cheque /0D/ Tax. 1D ‘Arrount Date Payoo Bank Branch