Admission Form Printed on 9/9/2023 1:56:53 PM

CHECK LIST

Program Name : Bachelor of Science- (Interior Design)

Account No. : 12332886

Documents:- Yes No
10th Mark Sheet [ ] [ ]

12th Mark Sheet [ ] [ ]

Graduation [ ] [ ]

Diploma [ ] [ ]

Character [ ] [ ]

Migration [ ] [ ]

Provisional [ ] [ ]

Others [ ] [ ]

Photographs (5) [ ] [ ]

SC-Certificate [ ] [ ]

Domicile-Certificate [ ] [ ]

Income-Certificate [ ] [ ]

Adhar Card-Student [ ] [ ]

Adhar Card-Father [ ] [ ]

Adhar Card-Mother [ ] [ ]

Bank Account [ ] [ ]

Pending if any (Remarks) .........................................................................

Eligible/Not Eligible Admission

Employee Code: Rajesh Kumar (E5498)

Dealing Hand
Asstt. Registrar Office Supdt

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 Admission Form Printed on 9/9/2023 1:56:53 PM

Student Account No :12332886 Prospectus No :NA Enquiry No :9626800

Student Personal Detail Admission Process Detail

Gender Male University CHANDIGARH UNIVERSITY
Date Of Birth 18 Aug 2004 Course for Admission B.Sc (Interior Design):::ID201

Blood Group B+ Under Lateral Entry No

Religion Hinduism Semester 1
Name MEHUL BANSAL Migrated No
Mother's Name SUMAN RANI Country India
Father's Name RAJESH KUMAR Hostel Facility No
Category GEN Transport Facility NA
Nationality Indian Transport Route NA
Annual Income 500000.00 Program Fee 86500.00 INR

From where did you first hear about us: Other Aadhar Card Number 921124095189

Student Contact Information

Permanent Address Correspondence Address
HISAR(125001) HISAR(125001)
Country India Country India
Pincode 125001 Pincode 125001
City Hisar, Haryana City Hisar, Haryana

District Hisar District Hisar

State Haryana State Haryana

Type Mobile No Landline No Office LL No Email Id Education Level Occupation

Mother 9416140801 NA NA GRADUATE BUISNESS
Student 7206693960 NA NA sumanbansalap@gmail.com

Student Qualification Details

Degree University Board Total M.Obtained CGPA % Year Main Subjects Status School Name
10th CENTRAL BOARD OF 500 273 54.6 2020 GENERAL Declared ST FRANCIS XAVIER SCHOOL
SECONDARY EDUCATION (Hisar)
10+2 CENTRAL BOARD OF 500 386 77.2 2022 MEDICAL Declared BRAHMA SHAKTI
SECONDARY EDUCATION PUBLICSCHOOL (New Delhi)

Student Exam Details

Exam Name Exam Rank Score Passing Year

Counselor Signature Parents/Guardians Signature OR Student Signature

Rajesh Kumar (E5498) RAJESH KUMAR MEHUL BANSAL (12332886)

CHANDIGARH UNIVERSITY Printed on 9/9/2023 1:56:53 PM

Account No : 12332886 Date for Registration : : Aug 29 2023 11:04AM

Program : B.Sc (Interior Design):::ID201 Program Fee : : 86500.00 INR

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Did you appear for any National/State ent rance test(s)? Yes / No ......................................................
Mention the Name and Percent Score of the Test you want to be considered: ..........................................................
(Please attach a photocopy of your test score.)
Please mention if you have any achievements in Sports/ Co-curicullar activities at the National/ International/ State Level

_____________________________________________________________________________________________________

DECLARATION BY STUDENT

• I do hereby declare that particulars given in this registration form are complete, correct and true to the best of my knowledge
and belief.
• I understand that my registration is provisional for admission to the University, subject to the fulfillment of eligibility conditions
and verification of documents.
• I will produce all required original documents on or before 30th June 2023. If I fail to submit required documents on the
stipulated date and fail to pay full fee my admission will stand cancelled
• If at later stage my documents are found to be fake, I will be solely responsible for legal consequence and will not claim any
refund of fee/ seat from the Institute/ University on any account whatsoever.
• I am not suffering from any contagious or chronic disease abd medical fit to study in Chandigarh University .
• I am aware that my post matric scholarship amount will be credited under the DBT process by the state/Center Govt to my
account. I will be bound to pay it to the university within one week from the receipt of the amount.

___________________ ___________________________
Student’s Signature Signature of Parent/Guardian

Father's Name: RAJESH KUMAR Mother’s Name: SUMAN RANI

Designation: ..................................................................... Designation: ....................................................................

Office Address: ................................................................. Office Address: ................................................................

....................................................................................... ......................................................................................

Note: Please attach:

I) Photocopies of Detailed Marks Sheets (Graduation, 10+2, Matric, Diploma, Character, Migration, etc
ii) Four Passport size photographs
_____________________________________________________________________________________________________
FOR OFFICE USE ONLY

Step – 1. I have checked the eligibility conditions applicable in the above said course and the candidate agrees to fulfill these
conditions.

(Admission Counselor)

Step – 2. I have received fee amount vide Receipt No. .......................... dated .......................... Amount .......................... from
the student and balance fee .......................... will be paid on or before ...........................

(Admission Incharge)

Step – 3. I have received fee amount vide Receipt No. .......................... dated .......................... Amount ..........................

(Cashier)

Step – 4. The Admission has been approved after verification of original documents.
Pending documents (if any) ..............................................................

(For-Registrar)

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 UNDERTAKING OF CYBER CRIME

I, MEHUL BANSAL S/o, D/o RAJESH KUMAR registered for admission in Course Bachelor of Science- (Interior Design)
Batch 2023 Sem 1 for academic session 2023-2024 at Chandigarh University, do hereby undertake that:

1. I am aware that Cyber Crime is strictly prohibited and unlawful act by the law.

2. I will not indulge in any kind of Cyber crime including Cyber-Stalking, Dissemination of Obscene Material , Defamation,
Hacking, Cracking, E-Mail Spoofing, SMS spoofing, Carding, Cheating and Fraud, Child Pornography, Assault by Threat,
Intellectual Property Crimes, Cyber Squatting, Cyber Vandalism, Transmitting Virus, Cyber Trespass, Cyber Terrorism, Cyber
Warfare, Possession of Unauthorized Information.

3. I am aware that the infringement of the above undertaking makes me liable for disciplinary action as deemed fit by the
University rules including punishment in the form of expulsion from classes, University campus and the hostel.

4. I have fully understood that if I am found guilty of cyber crime then I shall be punished as per the provisions of Section 66-A
of Information Technology Act, 2008 and may be punished with imprisonment up to 3 years alongwith fine under the court of
law.

Date:…………………………… (Signature of Student)

Name……………………………………………

I,…………………………………………………………have carefully read and clearly understood the content of the above
undertaking, I do hereby undertake that I shall be jointly responsible if my son/ward is found indulging in any act of indiscipline
or misconduct or ragging or cyber crime. The University may take any disciplinary action against my son/ward.

(Signature or Parent/Guardian)

Date:…………………………………… Name…………………………………………………….

Relation………………….……………………………..

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UNDERTAKING FORM MANDATORY TO BE UNDER UGC REGULATIONS ON CURBING THE MENACE OF RAGGING IN
HIGHER EDUCATIONAL INSTITUTIONS, 2009

AFFIDAVIT BY THE STUDENT

I, MEHUL BANSAL s/o, d/o RAJESH KUMAR has taken admission in course Bachelor of Science- (Interior Design) session
2023-2024 student of Chandigarh University, Gharuan, Mohali, do here undertake on this day 29 month Aug year 2023 the
following :-

1. That I have read and understood the directives of the Hon’ble Supreme Court of India on anti ragging and the measures
proposed to be taken in the above references (available on the website “www. cuchd.in”). I have, in particular, perused clause 3
of the Regulations and am aware as to what constitutes ragging.

2. That I understand the meaning of Ragging and know that ragging in any form is a punishable offence and the same is
banned by the Court of law.

3. That I have not been found or charged for my involvement in any kind in any kind of ragging in the past. However, I undertake
to face disciplinary action/legal proceeding including expulsion from the University if the above statement is found to be untrue
or the facts are concealed, at any stage in future. I have also, in particular, perused clause 7 and clause 9.1 of the Regulation
and am fully aware of the penal and administrative action that is liable to be taken against me in case I am found guilty of or
abetting ragging, actively or passively, or being part of a conspiracy to promote ragging.

4. I hereby solemnly aware and undertake that:

a. I will not indulge in any behavior or act that may be constituted as ragging under clause 3 of the Regulations.
b. That I will not participate in or abet or propagate through any act of commission or omission that may be constituted as
ragging under clause 3 of the Regulations.

5. I hereby affirm that, if found guilty of ragging, I am liable for punishment according to clause 9.1 of the Regulations, without
prejudice to any other criminal action that may be taken against me under any penal law or any law for the time being in force.

6. That I shall not resort to ragging in any form at any place and shall abide by the rules/laws prescribed by the courts, Govt. of
India and the University authorities for the purpose from time to time.

Signature of Student
I hereby fully endorse the undertaking made by my child/ward.

Signature of Mother/Father and or Guardian

Witness:

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 UNDERTAKING FROM STUDENTS FOR NON SUBMISSION OF DOCUMENTS

(TO BE GIVEN BY CANDIDATES WHOSE RESULT OF QUALIFYING EXAM IS NOT DECLARED OR WHO HAD ANY
COMPARTMENT/ BACKLOG)

“I MEHUL BANSAL s/d/o Sh RAJESH KUMAR bearing UID/Account No. 12332886 had taken provisional admission in
Bachelor of Science- (Interior Design) Course in the session 2023-2024, do hereby solemnly undertake that I will produce
the proof of passing of my Qualifying examination with the minimum percentage of marks required on or before 30 Sep 2023,
failing which my admission shall stand cancelled.

Dated: ............................ Signature of candidate

Signature of Parent/Guardian

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 CHANDIGARH UNIVERSITY
…
ACKNOWLEDGEMENT SLIP
Account No : 12332886 Date ............................

Received Original documents against temporary Account No. 12332886 pertaining to Mr./ Ms MEHUL BANSAL son/
daughter of Sh RAJESH KUMAR admitted to course Bachelor of Science- (Interior Design) Session: 2023-2024.

Submitted Document: Pending Document:

1. ............................................................................ 1. ..........................................................................

2. ............................................................................ 2. ..........................................................................

3. ............................................................................ 3. ..........................................................................

4. ............................................................................ 4. ............................................................................

5. ............................................................................ 5. ............................................................................

Any Other: .............................................................. Any Other: .............................................................

Name of the Dealing person with E-Code: Rajesh Kumar (E5498)

Signature and date : .........................................

CHANDIGARH UNIVERSITY
…
ACKNOWLEDGEMENT SLIP
(Parents Copy)
Account No : 12332886 Date ............................

Received Original documents against temporary Account No. 12332886 pertaining to Mr./ Ms MEHUL BANSAL son/
daughter of Sh RAJESH KUMAR admitted to course Bachelor of Science- (Interior Design) Session: 2023-2024.

Submitted Document: Pending Document:

1. ............................................................................ 1. ..........................................................................

2. ............................................................................ 2. ..........................................................................

3. ............................................................................ 3. ..........................................................................

4. ............................................................................ 4. ............................................................................

5. ............................................................................ 5. ............................................................................

Any Other: .............................................................. Any Other: .............................................................

Name of the Dealing person with E-Code: Rajesh Kumar (E5498)

Signature and date : .........................................

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