Dr. M. V.

SHETTY GROUP OF COLLEGES

[Managed by Dr. M.V. Shetty Memorial Trust (R)]
Vidyanagar, Mangaluru- 575 013, Karnataka , India
Tel. : 0824 - 2481285, 2481048 | Fax : 0824 - 2485353 | Mobile : +91 7760495280, +91 9483414480
E-mail : drmvsgroup@gmail.com | Website : www.mvshettycolleges.edu.in

No. Reg. No.

Admission for the year Course

Speciality Preferred For PG

Applicants Name (Full Name in Block Letters)

Ph. No. : E-mail Id.

Father’s Name (Full Name) Occupation

Mother’s Name (Full Name) Occupation

Annual Income of Parents

Personal Detail
Date Blood Mother Marital
Sex Group Religion Caste Category Tounge Nationality Status
of Birth

Parent’s / Guardian’s Address (Block Letters) Present Address (Block Letters)

Address : Address :

State : State :
Pin Code : Pin Code :
Phone : Phone :
E-mail ID : E-mail ID :

Academic Particulars
Exam Name & Address of the School/ Colleges Name of Reg. Year & Month Class Private
Passed Board/Uni. No. of Passing Passed or regular

1) 10th

2) PUC or
10+2
or VHS

3) Degree

4) Any
Other
Exam
Details of 10 + 2 / Degree (Marks obtained in various subject)
Sl. Subjects Max. Marks Marks Percentage
No. Obtained

Overall Percentage

Details of Fees Paid

1. Application and Prospectus Fee Rs. 500/- Paid To be paid
2. Registration Fee Rs. 250/- Paid To be paid

Fee Structure issued - Yes / No

DECLARATION BY THE CANDIDATE

I hereby state that I have filled this form myself, and to the best of my knowledge and belief, the particulars given
above are true.
I hereby undertake to abide by all the conditions, rules and regulation in force at present and also those which
may hereafter be introduced by the administration of the college. I will do nothing unworthy of a student of the
college either inside or outside or anything that will interfere with its orderly working and discipline. I am aware that
the management has the full authority to expel me for my lack of interest in studies, misbehavior, continuous failures
and for other valid reasons. i hereby undertake that i shall not indulge in ragging or in abetting ragging other students
of the college. i am aware that ragging or abetting is liable to be punished.
I also undertake that I shall pay all the fees and other dues to the institution promptly on demand. I have
thoroughly read the prospectus and understood the contents of it. I shall pay the college fees for the whole course
period if I withdraw from the college anytime after admission and before completion of the course.

Place :

Date : Countersigned by the Parent / Legal Guardian Signature of the Applicant