‘The portal is open for online admission to the college if and only if the seats are vacant in the given course. In case seats are not available there will be no claim for admissions. Govt. College, Ateli, Mahendergarh Session 2016-17 APPLICATION FOR ADMISSION Print Date: 6/27/2016 7:39:37 PM Registration Date: 27/06/2016 Form No./UserName: 2811244304 Password: 93432301 For Office Use ‘lass Roll No. ‘Admission Form Fee Receipt Date } ‘Signature ° [Course (Class/Semester 2B.Sc. (Non-Medical)-T ‘Applicant's Name Date of Birth(OD/MM/yyyy) :04708/1998 (Gender Father's Name :MrPurushotam [Father's Occupation Office Address :N/A ‘Mother's Name Category, "SC/ST ‘Mother's Occupation Religion Hindu 'BPL Card No Mode of Transport jone (Caste Marital Status "Un Married ‘Are you Employed at Domicile :Haryana Present \Nationality SINDIAN Sports Grade :None ‘Annual Income of Family Less Than Rs.1,00,000 Per [Area Type(Urban/Rural) :Rurel num ‘Have you ever been :No Gap Year(if any) :NO \disqualified from any Exam ‘Is NCC : Is NSS 'Wheather Applying for Hostel Gaurdian's Name ‘Adhaar Enrolment 1D ‘Adhaar Number fi [Bank Name =Syndicate bank Bank Account Number 8263221011577 IFSC Code 2SYNB0008203 Other Bank Name :N/A ADDRESS DETAILS ‘Address : Shubham Son of Purushotam,V.Thana,PO. kultafpur ‘State Haryana District iMahendergarh Pin Code 2123001 Email 1d :randhirsingh7634@gmail.com [Land Line No N/A Mobile No. 19467575839EDUCATIONAL QUALIFICATION Exam Passed ersity RollNo | Passing | Marks | Max Marks | Percentage Year Obt 10th/Matric Haryana Board of Education |2213734824| 2014 400.00 500 80.00 ‘Secondary Haryana Board of Education |3215759199| 2016 303.00 500 60.60 DOCUMENTS TO BE ATTACHED a) Original Character Certificate (From Institute/Schoo! Last attended) In case of Gap Year /Private Candidate ~ Issued by ‘Sarpanch/M.C/Any Gazetted Officer. b ) Matric Certificate( On Copy) c) +2 Centficate (2 copies) d) Migration Certificate ( Original and One Copy) ¢) Mark sheet of Last Qualifying Exam (One Copy) ) S.C/B.C,/S.1/BPL Certificate ( One Copy) @) Haryana Domicile for Reserved Categories hh) Gap Year Candidate to attach affidavit as per Prospectus. i) Any other certificate (Specify) j) Photocopy of Bank Account No. or Aadhaar Card/E-ID. kj Any other relevant document for claim of weightage like NCC/NSS/Sports/Rural Area etc as per prospectus. hereby declare that I had gone through the provisions mentioned in Haryana Education Institutions Antiragging Act (2012)and | will adhere to all the provisions mentioned in the Act and will not indulge in any activity which falls under the clause of raging as per the Act, Parent's Signature Student Signature RECIEPT Received application form from Mr./Ms Shubham Class BSc. Form No. 2811244304 Date: Signature of Receiver Note: Last date of application form submission in College is 30/06/2016