9/15/2020 S.M.J.N. (P.G.

) COLLEGE, HARIDWAR, UTTARAKHAND| Session 2020-21

Application Form for Admission (Session 2020-21)

App.No. : 202545

Class : BA III ( Sem III (Aided) )

Subject : History, Sanskrit, SEC - Sanskrit, Hindi Literature

Name : GANGA

Date of Birth : 4-Jun-2002

Gender : Female

Category : GEN

Sub Cat :--

Mobile No. : 9690988721

Father's Name : LALA RAM KORI Father's Mobile :9760219318 Parents Email :

Mother's Name : RAJKUMARI Mother's Mobile : 9760219318 Nationality : Indian

Permanent Address : JHALKARI BASTI BILKESHWAR ROAD HARIDWAR UK State : Uttarakhand

Guardian Name : Relationship : Guardian Mobile No.:

Local Address : JHALKARI BASTI BILKESHWAR ROAD HARIDWAR UK Religion : HINDU Do you belong to Minority ? : NO

Email : yogeshpandey259@gmail.com Blood Group : A+ Aadhar No. : 405391542781

Have you Passed the Qualifying Exam from Uttarakhand ? : YES

Are you Resident of Uttarakhand ? : YES Duration of Residence : Uttarakhand Region : NONE

Board/Univ.: HNB GARHWAL UNIVERSITY Last Examinations Passed : B.A Institute Last Attended : SMJN PG COLLEGE HARIDWAR Passing Year : 2020

Educational Qualification

Examination Year Institution/Board Subject Offered Division With %

High School 2017 UK BOARD HINDI SANSKRIT HOME SCIENCE SCIENCE SOCIAL SCIENCE 61.80
Intermediate 2019 UK BOARD HINDI SANSKRIT HISTORY DRAWING & PAINTING POLITICAL SCIENCE 62.60
B.A I 2020 HNB GARHWAL UNIVERSITY ARTS 63.00

Q1. Have you been caught using unfair means in any examination ? NO
Q2. Have you been punished for using unfair means in any examination ? NO
Q3. Have you applied for admission in any other course in any institution ? NO
Q4. Are you studying, at present, in any other course in any institution ? NO
Q5. Are you employed, at present, in any organisation (public or private) ? NO
Q6. Have you faced any legal trial for any offense ? NO

AFFIDAVIT TO BE FILED AND SIGNED BY THE STUDENT AND COUNTER SIGNED BY FATHER/MOTHER/GUARDIAN

I,GANGA S/o.D/o.Mr./Mrs./Ms.LALA RAM KORI, solemnly, declare that all information provided by me in this application for admission are true to the best of my belief.
I have also carefully read and fully understood the rules and regulations of the Central Government / UGC /Government of Uttarakhand / HNB Garhwal University and
the college. I hereby undertake that

1. I shall abide by all the rules and regulations of the above-mentioned authorities.
2. I have selected course after careful thought and will not request for any change after recommendation by the admission committee.
3. I shall achieve the target of 75 per cent attendance in every course separately and will appear in all internal and external examinations.
4. I shall not indulge myself in any act of indiscipline and ragging.
5. I have filled online & attached affidavits for not indulging in ragging of any type and at any level.

I hereby agree that if found guilty of any aspect of ragging, indiscipline,violation of rules and regulations and providing false information given in this form, I may be
punished as per the provisions of the government/university/college. I hereby also agree that if my admission is found against rules and regulations, I shall have no
objection for cancellation of my admission thereof.

Signed this _________________ day of _______________ month of _____ year _____

GANGA Countersigned by Father/Mother/Legal Guardian of Applicant

1/2
9/15/2020 S.M.J.N. (P.G.) COLLEGE, HARIDWAR, UTTARAKHAND| Session 2020-21
Date.............

Undertaking By Candidates

I GANGA of course BA III ( Sem III (Aided) ), hereby affirm and state as the document and other information submitted by me to the college are true to the best of my
knowledge and belief. I understand that if any document or information is found to be false, admission shall be liable to get cancelled and fee deposited will be
forfeited.

GANGA

Payment Reciept

Payment Type : Prospectus/Registration Fee Amount : 220

Paid On : CC 15-9-2020 Trxn No. : 500103328479

FOR OFFICE USE ONLY

Recommended /Unrecommended for Admission

Recommendation of Admission Committee
1.
2.
3.

Principal

2/2