‘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, Narnaul Session 2016-17 APPLICATION FOR ADMISSION Print Date: 6/25/2016 11:38:14 AM Registration Date: 25/06/2016 Form No./UserName: 16411227238 Password: 39891705 For Office Use ‘Class Roll No. ‘Admission Form Fee Receipt (Date } ‘Signature [course (Class/Semester :B.Sc, (Non-Medical)-T ‘Applicant's Name Date of Birth(OD/MM/yyyy) :04708/1998 (Gender Father's Name :Purushotam ‘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 TINDIAN Sports Grade =None [Annual Income of Family —:Le55 Than Rs.1,00,000 Per Arca Type(Urban/Rural) :Rural num ‘Have you ever been =No Gap Year(if any) =No disqualified from any Exam Is NCC ‘Is NSS Yes: 'Wheather Applying for Gaurdian's Name =N/A Hostel ‘Adhaar Enrolment 1D ‘Adhaar Number b (Bank Name =Syndicate bank Bank Account Number 8263221011577 IFSC Code =SYNB0008263 Other Bank Name =N/A ADDRESS DETAILS ‘Address : Shubham son of Purushotam, V.Thana,PO, kultajpur [State Haryana District iMahendergarh Pin Code 2123001 Email Id =randhirsingh7634@amail.com [Land Line No N/A Mobile No. 19467575839EDUCATIONAL QUALIFICATION ‘Exam Passed University RollNo | Passing | Marks | Max Marks | Percentage Year Obt ‘LOth/Matric Haryana Board of Education |2213734824| 2014 400.00 500 80.00 ‘Secondary. Haryana Board of Education [3215750199] 2016 303.00 500) (60.60 ‘SUBJECTS OFFERED Preference [Subjects 1 Physics,Chemistry, Mathematics 2 [Chemistry Physics, Geology 3 [Chemistry Geology, Mathematics 4 Physics, Mathematics Geology 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) ©) +2 Centiicate (2 copies) d) Migration Certificate ( Original and One Copy) ) Mark sheet of Last Qualifying Exam (One Copy) ) S.C/B.C,/S.T/BPL Certificate ( One Copy) 4) Haryana Domicle for Reserved Categones 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. ke Any other relevant document for claim of weightage like NCC/NSS/Sports/Rural Area etc as per prospectus. Thereby declare that I had gone through the provisions mentioned in Haryana Education Institutions Antiragging Act (2012)and 1 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. 16411227238 Date: Signature of Receiver Note: Last date of application form submission in College is 30/06/2016