UNIVERSITY OF KASHMIR

Hazratbal Srinagar - 190006

Form No: ADU-1612035

Form for admission to Integrated MBA

for the session 2021 Enrollment No

MOHAMMAD RAFIQ DAR

1. Name Affix Self
Attested
ABDUL KHALIQ DAR Passport Size
2. Father's Name
Photograph
3. Regd. No 302-NC-2016 4. (i) Date of Birth
(dd/mm/yyyy)

(ii) Place of Birth 5. Nationality

6. Permanent home address

7. Address for correspondence

8.(i) District (ii) Cell No (iii) Phone No

9. Whether a permanent resident of J&K State (Yes / No)

10. Occupation of Father/Guardian

11. Are you presently on the rolls of any Deptt. of this University. If yes, indicate the name of the Deptt

12. State the particular category if selected under any of the reversed categories
13. Academic Record

Name of the Year of Marks % age Division/ Regd.No College/Institution

Exam. Passing Obtained Distinction through which passed

12th

Graduation
(Aggregate)

Any other

14. Do you want to reside in the hostel ( Yes / No )

I solemly declare/undertake that;

i) The particulars given above are correct.
ii) I will obey all the statutes /regulations related to admission and also the instructions that may be issued from time to
time by the University in this behalf. Any violation of the statutes and regulations of the University by me shall render
me liable to such punishment, disciplinary action, including cancellation of admissions, as the University authorities
may impose on me.
iii) I am not serving in any Govt/Semi-Govt/Private institution or concern nor shall I serve or join any appointment during
the tenure of the present program in the University.
iv) I am serving in the Department _________________________________________________ as a
_____________________________________________ and have obtained permission of my employer for joining
the course / programme in the University .
vi) I am not enrolled for any other course in any other Department of this University or any other University.
Date
Signature of the applicant
 Form No: ADU-1612035
Declaration by Parent/Guardian

I am responsible for the conduct of my ward namely MOHAMMAD RAFIQ DAR in the University and undertake to pay
his/her dues and bear his/her expenses on books, tours and excursions. I am liable to make good any loss or damage to
the University property which may be caused as a result of misconduct of my ward.

Date: Sig. of Parent/Guardian

Name:__________________________

Address:________________________

Note: The Candidtes must approach the concerned Department and obtain permission from HOD for
depositing the fee in the Bank.
 THE UNIVERSITY OF KASHMIR
Hazratbal Srinagar-190006 Form No: ADU-1612035

To be sent to the Dean Students Welfare by the Department after the completion of admission process.

1. Name MOHAMMAD RAFIQ DAR

2. Father's Name ABDUL KHALIQ DAR

3. Department

4. Date of Admission

5. Class Roll No 6. Registration No 302-NC-2016

7. Permanent home address

8. Address for correspondence

District Contact No

9. Date of Birth

10. Academic Record

Name of the Year of Marks % age Division / Regd.No College/Institution

Exam. Passing Obtained Distinction through which passed

Dated

Signature of the applicant

Forwarded in original to the Dean, Students welfare with the report that the candidate in question has
completed admission formalities and has deposited all the dues in the University Chest.

Signature of the Head of the

Dated Deptt.with official seal

Department:

Received Annual Student's Magazine and Identity Card bearing No

Signature of the Students

 UNIVERSITY OF KASHMIR, SRINAGAR
FOR THE USE OF CHIEF PROCTOR 'S OFFICE
Form No: ADU-1612035
CARD INDEX NO: YEAR/SESSION:
Integrated MBA
Course Admitted to Faculty

1. Name of the student MOHAMMAD RAFIQ DAR 2. Father's Name ABDUL KHALIQ DAR

3. Father's Profession 4. Gender : Male / Female

5. Date of Birth 6.Semester 7.Roll No

8. Contact No (a) Candidate's (b) Parent's

(c) Local Aquaintee's / other contact No

9. Examination passed before Joining the University
Exam / Class Year Marks Obt. %age Roll No Category School / College

12 th
Graduation (Aggregate)

Any Other
10. Examination passed after Joining the University
Session Class Year Roll No Marks Obt. %age Semester Aggregate Marks

11. Hostel Records

(a) Name of the Hostel Admitted to
(b) Date of Admission (c) Room No
(d) Permanent Home Address

I certify that every detail provided by me in this format is true to the best of my knowledge.

Signature of Students /Date

Signature of HOD / Date Signature of Chief Proctor / Date

Conduct Record of the Student (For Office Use Only)

S.No. Details of Episode Date / Year Final Report / Status Sign. of IO Sig. of CP

Details of Issuance of Conduct Certificate

Receipt No Date Sign. of Clerk Sign. of Sign. of Sign. of

/ SO Proctor DCP CP

Note:- This duly filled format is required to be submitted at the office of the Chief Proctor within fifteen days after
completing admission at the department.No form will be entertained thereafter.
This fee slip is to be deposited at directorate of IT&SS

The Jammu and Kashmir Bank Limited

IT&SS Copy
Dated: 09-Aug-2021 Form No ADU-1612035
Name : Parentage: ABDUL KHALIQ DAR
MOHAMMAD RAFIQ DAR
Address:
Mobile:

Purpose: Account No: Amount (Rs)

Part A 0007040500001001 6300

Part B 0140010100004343 5500

Part C i) Library Fee 0007010100000268 800

ii) Chief Proctor 0007040100017274 200
iiI) Internet Fee 0007040500001126 300
iv) DSW Fee 0007040100013798 75

Sign. of Depositer Bank Seal & Signature

 The Jammu and Kashmir Bank Limited
Students Copy
Dated: 09-Aug-2021 Form No ADU-1612035
Name : MOHAMMAD RAFIQ DAR Parentage: ABDUL KHALIQ DAR

Address:
Mobile:

Purpose: Account No: Amount (Rs)

Part A 0007040500001001 6300

Part B 0140010100004343 5500

Part C i) Library Fee 0007010100000268 800

ii) Chief Proctor 0007040100017274 200
iiI) Internet Fee 0007040500001126 300
iv) DSW Fee 0007040100013798 75

Sign. of Depositer Bank Seal & Signature

The Jammu and Kashmir Bank Limited

Departments Copy
Dated: 09-Aug-2021 Form No ADU-1612035
Name : Parentage: ABDUL KHALIQ DAR
MOHAMMAD RAFIQ DAR
Address:
Mobile:

Purpose: Account No: Amount (Rs)

Part A 0007040500001001 6300

Part B 0140010100004343 5500

Part C i) Library Fee 0007010100000268 800

ii) Chief Proctor 0007040100017274 200
iiI) Internet Fee 0007040500001126 300
iv) DSW Fee 0007040100013798 75

Bank Seal & Signature

Sign. of Depositer

The Jammu and Kashmir Bank Limited

Bank Copy
Dated: 09-Aug-2021 Form No ADU-1612035
Name : Parentage: ABDUL KHALIQ DAR
MOHAMMAD RAFIQ DAR
Address:
Mobile:

Purpose: Account No: Amount (Rs)

Part A 0007040500001001 6300

Part B 0140010100004343 5500

Part C i) Library Fee 0007010100000268 800

ii) Chief Proctor 0007040100017274 200
iiI) Internet Fee 0007040500001126 300
iv) DSW Fee 0007040100013798 75

Sign. of Depositer Bank Seal & Signature

Mr/Ms MOHAMMAD RAFIQ DAR selected for the program in the Dept. of_____________________ is authorized to deposite the
admission Fee.
Signature of the Head of the
Department with official seal
 The Jammu and Kashmir Bank Limited
Library Copy
Dated: 09-Aug-2021 Form No ADU-1612035
Name : Parentage: ABDUL KHALIQ DAR
MOHAMMAD RAFIQ DAR
Address:
Mobile:

Purpose: Account No: Amount (Rs)

Part A 0007040500001001 6300

Part B 0140010100004343 5500

Part C i) Library Fee 0007010100000268 800

ii) Chief Proctor 0007040100017274 200
iiI) Internet Fee 0007040500001126 300
iv) DSW Fee 0007040100013798 75

Sign. of Depositer Bank Seal & Signature

The Jammu and Kashmir Bank Limited

Proctor Office Copy
Dated: 09-Aug-2021 Form No ADU-1612035
Name : Parentage:

Address:
Mobile:

Purpose: Account No: Amount (Rs)

Part A 0007040500001001 6300

Part B 0140010100004343 5500

Part C i) Library Fee 0007010100000268 800

ii) Chief Proctor 0007040100017274 200
iiI) Internet Fee 0007040500001126 300
iv) DSW Fee 0007040100013798 75

Sign. of Depositer Bank Seal & Signature

The Jammu and Kashmir Bank Limited

DSW Copy
Dated: 09-Aug-2021 Form No ADU-1612035
Name : MOHAMMAD RAFIQ DAR Parentage: ABDUL KHALIQ DAR

Address:
Mobile:

Purpose: Account No: Amount (Rs)

Part A 0007040500001001 6300

Part B 0140010100004343 5500

Part C i) Library Fee 0007010100000268 800

ii) Chief Proctor 0007040100017274 200
iiI) Internet Fee 0007040500001126 300
iv) DSW Fee
0007040100013798 75

Sign. of Depositer Bank Seal & Signature

Mr/Ms MOHAMMAD RAFIQ DAR selected for the program in the Dept. of_________________________ is authorized to deposite the
admission Fee. Signature of the Head of the
Department with official seal