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    Sanjeet Kr
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    This document is an undergraduate admission registration form for Patliputra University in Patna, Bihar, India for the 2019-2020 session. It contains details of the applicant such as name, father's name, date of birth, category, address, qualifications, college and course preferences, and a declaration signed by the applicant and parent/guardian. The applicant is providing documents such as marksheets, certificates, photographs as required for the registration.

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    This document is an undergraduate admission registration form for Patliputra University in Patna, Bihar, India for the 2019-2020 session. It contains details of the applicant such as name, father's name, date of birth, category, address, qualifications, college and course preferences, and a declaration signed by the applicant and parent/guardian. The applicant is providing documents such as marksheets, certificates, photographs as required for the registration.

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    © All Rights Reserved
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    31 views2 pages

    19G0001030

    Uploaded by

    Sanjeet Kr
    This document is an undergraduate admission registration form for Patliputra University in Patna, Bihar, India for the 2019-2020 session. It contains details of the applicant such as name, father's name, date of birth, category, address, qualifications, college and course preferences, and a declaration signed by the applicant and parent/guardian. The applicant is providing documents such as marksheets, certificates, photographs as required for the registration.

    Copyright:

    © All Rights Reserved
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    of 2

    Patliputra University, Patna

    Under-Graduate (UG) Admission Registration Form


    SESSION 2019 - 2020
    URN # 19G0001030 Reg. Date : 13 May, 2019 05:04 PM

    1. Candidate Name : SANJEET KUMAR


    2. Father's Name : DINESH MISTRI
    3. Mother's Name : NUTAN DEVI
    4. Date of Birth : 02-Feb-2002 5. Gender : MALE
    6. Category : BC-I 7. Sub Category : Not Applicable

    8. Other Category : Not Applicable 9. AADHAAR : 831082250979


    10. Domicile : Bihar 11. Dom. Cert. :
    12. Religion : Hindu 13. Minority : NO
    14. Nationality : INDIAN 15. EWS Status: Not Applicable

    16. Address for Correspondance : 17. Permanent Address :


    AT KOYRIBIGHA PO BARBIGHA PS BARBIGHA DIST AT KOYRIBIGHA PO BARBIGHA PS BARBIGHA DIST
    SHEIKHPURA SHEIKHPURA
    Sheikhpura Sheikhpura
    Bihar Bihar
    PIN Code : 811101 PIN Code : 811101

    18. Mobile : 8936884552 19. Email : sanjeetkr4552@gmail.com


    20. Payment Details: Paid Rs.300.00 on 13/5/2019 Ref# 8445527451 Bank Ref: VISA - 201913323878303
    21. Qualifications

    Examination Board/University Year Roll No. Max. Mrk. Obt. Mrk.

    Highschool Bihar School Exam. Board, Sinha Library Road, Patna 2017 1700680 500 278
    Intermediate Bihar School Exam. Board, Sinha Library Road, Patna 2019 19010473 500 300
    Subjects/Stream : Science

    Other Qualifications

    22. College/Course Chosen (by order of preference)


    1 [205] College of Commerce, Arts and Science, Patna B.A. Psychology (Hons) Psychology
    2 [201] A.N. College, Patna B.A. Psychology (Hons) Psychology
    3 [203] B.D. College, Patna B.A. Psychology (Hons) Psychology
    4 [225] T.P.S College, Patna B.A. Psychology (Hons) Psychology

    Declaration

    I declare that I have never been convicted for any criminal act and that there is no case pending
    against me in the court of law. I also declare that I have never been caught using Unfair Means or
    any Disciplinary action has been taken against me. If I was charged for using Unfair Means, the
    punitive duration is over and charges have been cleared. I have read carefully and have understood
    all rules as mentioned in the University Rules and Admission Brochure. Furthermore I also declare
    that if my application is found to contain incorrect/false information regarding my Name, Birth Date,
    Gender, Religion, Domicile, Weightage, Caste, Horizontal Reservation, Marks obtained or any other
    field, my application is liable to get cancelled, and I will have no objection in getting disqualified for
    admission to the concerned course/college.

    Signature of Parent/Guardian Signature of Candidate


    Date: Date:

    Printed: Sunday, June 30, 2019 07:06 PM Page: 1/2


    Patliputra University, Patna
    Under-Graduate (UG) Admission Registration Form
    SESSION 2019 - 2020
    URN # 19G0001030 Reg. Date : 13 May, 2019 05:04 PM

    Options checked during registration


    »
    Document Checklist
    NOTE: Mark the number of documents ( Photocopy/Xerox) attached by the Candidate during form submission to the college

    Xth Marksheet Xth Certificate


    XIIth Marksheet Last Exam Passed Marksheet
    Recent Passport Sized Photograph Scanned Signature
    Domicile (for other state) Certificate for Kashmiri Resident
    Certificate for Category Certificate for Sub-Category
    Documents for Claiming Weightage Other Certificate/Document

    Printed: Sunday, June 30, 2019 07:06 PM Page: 2/2

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