Chhatrapati Shahu Ji Maharaj University, Kanpur

Post-Graduate (PG) Admission Application Form

SESSION 2020 - 2021
AppNo # 20P0292901 Note: This is not W.R.N. App. Date : 16 June, 2021 05:31 PM

1. Candidate Name : SANJIP

2. Father's Name : LAKHMI CHAND
3. Mother's Name : RAJPATI
4. Date of Birth : 15-Apr-1995 5. Gender : MALE
6. Category : S.C. 7. Sub Category : Not Applicable

8. Other Category : Not Applicable 9. E.W.S. ** : Not Applicable

10. Domicile : Haryana 11. Dom. Cert. :

12. Religion : Hindu 13. Minority : NO
14. Nationality : INDIAN 15. AADHAAR : 408609736034

16. Address for Correspondance : 17. Permanent Address :

DACHAR KARNAL DACHAR KARNAL
Karnal Haryana 132024 Karnal Haryana 132024

18. Mobile : 9519786999 19. Email : JAYPALYADAV5@GMAIL.COM

20. Payment Details: Paid Rs.100.00 on 16/6/2021 Ref# 1471368360 Bank Ref: 1590 - 1471368360
21. Qualifications

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

Highschool Haryana Board of School Education, Hansi Road, Bhiw... 2011 2211810728 500 286
Intermediate Haryana Board of School Education, Hansi Road, Bhiw... 2014 3213314153 500 276
B.A. Kurukshetra University, Kurukshetra- 136 119, Haryan... 2018 4320003 430 206
Subjects/Stream : English,Hindi,Geography

Other Qualifications

Weightage Claimed Claimed Weightage

** E.W.S. gsrq ƒå çfr'kr dh lhek rd vkj{k.k mÙkj çns'k 'kklu dh vf/klwpuk@'kklukns'k ds vuqlkj ns; gksxk

22. Choice of College / Course Combination :

1 [KJ87] OM SAI VIDHI MAHAVIDYALAYA, ARIFPUR, SORI L.L.B (3 years) Law

This is not W.R.N.; W.R.N. will be generated/issued after application fee payment and confirmation in a degree/subject by the college.
Printed: Tuesday, June 22, 2021 07:40 AM Page: 1/3
 Chhatrapati Shahu Ji Maharaj University, Kanpur
Post-Graduate (PG) Admission Application Form
SESSION 2020 - 2021
AppNo # 20P0292901 Note: This is not W.R.N. App. Date : 16 June, 2021 05:31 PM
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. I understand that this is not WRN and WRN will be
issued/generated after application fee payment and confirmation in a degree/subject by the college.

Signature of Parent/Guardian Signature of Candidate

Date: Date:

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

अभयर्थियों हेतु आवशयक निर्देश

· आवेदन पत्र के प्रिंट आउट पर मारिंगी गई कुछ जानकारी अभ्यर्थी जैसे सनातक के पूराणांक, ्ापतारिंक, भारारिंक , स्ीम ,
महापवद्याल्य का नाम एवरिं कोस्स सव्यरिं भरेंगे तरा जजस महापवद्याल्य में ्वेश लेना चाहते हैं, पवशवपवद्याल्य के दवारा
ननरा्सररत अरिंनतम नतथर के पूव्स वारिंनछत ्मारपत्र्रों को सरिंलगन करते हुए जमा करेंगे |

· एक अभ्यर्थी एक ही परिंजीकरर कर सकता है | एक से अथरक महापवद्याल्य अरवा कोस्स में आवेदन करने हेतु, आवेदन
पत्र के प्रिंट आउट की फोटो कॉपी करा के ्त्येक महापवद्याल्य एवरिं कोस्स इत्यादद सव्यरिं भरते हुए पवशवपवद्याल्य के
दवारा ननरा्सररत अरिंनतम नतथर के पूव्स वारिंनछत ्मारपत्र्रों को सरिंलगन करते हुए जजस महापवद्याल्य में ्वेश लेना चाहते
हैं, जमा करेंगे |

· आवेदन में ककसी भी त्रुदट के ललए आवेदक खुद जजममेदार होगा|अतः आवेदन पत्र भरते वक़त एवरिं महापवद्याल्य में जमा
करने के पूव्स भली भारिंनत जाँच ले |

· अभ्यर्थी ्यह सुननजशचत कर ले कक जो मोबाइल नरिंबर उसने आवेदन फॉम्स में भरा है वह ककसी भी महापवद्याल्य में
उसका ्वेश समपुषट (Confirm) होने से पूव्स बरिंद नहीरिं होना चादहए तरा उसकी पहुरिंच में होना चादहए ।

· ककसी भी महापवद्याल्य में ्वेश लेते सम्य अभ्यर्थी के ददए गए रजजसटर्स मोबाइल नरिंबर पर एक OTP (One Time
Password) भेजा जा्येगा जो कक महापवद्याल्य दवारा करिंप्यूटर में फीर करने के उपरारिंत ही अभ्यर्थी का ्वेश समपुषट
(Confirm) होगा । अतः समसत अभ्यथर्स्य्रों को ्यरा सूथचत कक्या जाता है कक वे ्वेश के सम्य रजजसटर्स मोबाइल नरिंबर
के सार सव्यरिं महापवद्याल्य में उपजसरत रहें ।

This is not W.R.N.; W.R.N. will be generated/issued after application fee payment and confirmation in a degree/subject by the college.
Printed: Tuesday, June 22, 2021 07:40 AM Page: 2/3
 Chhatrapati Shahu Ji Maharaj University, Kanpur
Post-Graduate (PG) Admission Application Form
SESSION 2020 - 2021
AppNo # 20P0292901 Note: This is not W.R.N. App. Date : 16 June, 2021 05:31 PM

This is not W.R.N.; W.R.N. will be generated/issued after application fee payment and confirmation in a degree/subject by the college.
Printed: Tuesday, June 22, 2021 07:40 AM Page: 3/3