Reg. No.

…………………
Receipt No._______Date______
Amount Rs. ________________

CBS GROUP OF INSTITUTIONS

PERMISSION – CUM - ADMISSION FORM

MDU, ROHTAK

Examination Nov/Dec 2021

Paste
1. Name of Course & Branch: _________________________________________ Passport- size
Photograph
2. Name of Candidate: _______________________________________________

3. Father’s Name: ____________________________________________________

4. Address and Phone No. ----------------------------------------------------------------------------------------------------

___________________________________________________________________________________

_____________________________________________________________________________________

5. Subject in which the candidate wishes to appear (give subject code and name)

S.
No
. I Sem. II Sem. III Sem. IV Sem. V Sem. VI Sem. VII Sem. VIII Sem.
Pape Pape Pape Pape Pape Pape Pape
r r r r r r r
Subje Paper Subje Cod Subje Cod Subje Cod Subje Cod Subje Cod Subje Cod Subje Cod
  ct Code ct e ct e ct e ct e ct e ct e ct e
1                                
2                                
3                                
4                                
5                                
6                                

I solemnly declare that I have not been debarred on account of detention in Sessional/attendance / U.M.C./
misconduct/Non-deposit of fee/ having already in ____________ (month/year)

(Signature of Candidate) (Signature of Tutor Incharge)

Date ___________
(Certificate by the Principal)

Certified that ________________ is /was bonafide student of this institute.

Certified that particular given above by the candidate are correct as per official record.

(PRINCIPAL)