MAHARISHI UNIVERSITY OF

MANAGEMENT AND TECHNOLOGY

eaxyk] fcykliqj ¼N-x-½ MANGLA BILASPUR (C.G.) Passport
size photo
Form No. izos'k gsrq vkosnu i= attested by
APPLICATION FORM FOR ADMISSION Principal/HOD
Course Code-MUMT
Session.............

1- ukekadu la[;k % (Enrollment Number) :

2- 'kqYd fooj.k % lacf/kr ckWDl esa fVd ¼½ yxk;sa (Please tick ¼½ in box for fees payment mode) :

fMekaM Mªk¶V (Demand Draft) vkWuykbZu cSafdax (Online Banking) psd (Cheque)
Mh-Mh ua-@vkWuykbu cSafdax lanHkZ Ø-@psd ua- fnukad jkf'k ¼:i;ksa esa½
(D.D. No./ Online Banking Reference No./ Cheque No.) (Date) (Amount in Rupees)

fnukad ekg o"kZ

(Date) (Month) (Year)

cSad dk uke
(Name of the Bank)
3- lanHkZ dzekad (Reference Code)

4- ek/;e (Medium ) : vaxszth (English) fgUnh (Hindi)

5- uke (Name) :

6 ¼v½ firk dk uke %Jh] MkW- vkfn dk iz;ksx u djsa ¼tks mi;qDr u gks] mls dkV nsa½
(a) Father's Name (Do not use Mr.,Dr., Shri etc. Srike out which are not applicable)

¼c½ ifr dk uke % Jh] MkW- vkfn dk iz;ksx u djsa ¼tks mi;qDr u gks] mls dkV nsa½
(b) Husband's Name (Do not use Mr., Dr., Shri etc. Srike out which are not applicable)

¼l½ ekrk dk uke % Jhefr] MkW- vkfn dk iz;ksx u djsa ¼tks mi;qDr u gks] mls dkV nsa½
(c ) Mother's Name (Do not use Mr., Mrs., Dr. etc. Srike out which are not applicable)

7- Ik= O;ogkj ds fy, irk % ¼ckDl ua- dk irk u nsa]irs dh izR;sd bdkbZ edku@¶ySV ua-] LVªhV dk uke] ih-
vks- ds ckn ,d ckDl [kkyh NksM+ nsa½ (Address for Correspondence, Please do not write box no and leave a
box for space)

(i)
'kgj (City) ftyk (District)

jkT; (State) fiu dksM (Pin Code)

8- VsyhQksu ua- ,l-Vh-Mh- dksM lfgr (Phone No. with STD Code)

,l-Vh-Mh- dksM % (STD code) nwjHkk"k (Telephone No.)

eksckby ua- % (Mobile No.)

QSDl ua- ¼;fn gks½ ,l-Vh-Mh- dksM lfgr (Fax No. (if any) with STD code)

,l-Vh-Mh- dksM (STD code) QSDl ua- (Fax No.)

9- bZ&esy dk irk d`i;k lkQ&lkQ v{kjksa esa fy[ksa½ (E-mail Address)

10- tUe frfFk % (Date of Birth) frfFk (Date) ekg (Month) o"kZ (Year)

11- fyax% dsoy mi;qDr ckDl esa fVd ¼½ djsa (Sex: Please tick ¼½ in the appropriate box)

iq:"k (Male) efgyk (Female)

12- jk"Vªh;rk % dsoy mi;qDr ckDl esa fVd ¼½ djs (Nationality, Please tick ¼½ in the appropriate box)

Hkkjrh; (Indian) ;fn vU; d`i;k Li"V djsa (If other, Please mention) vU; (Other)

13- Js.kh % dsoy mi;qDr ckDl esa fVd ¼½ djsa (Category: Please tick ¼½ in the appropriate box)

lkekU; (General) vuq-tkfr (SC) vuq-tutkfr (ST) v-fi-o- (OBC)

14- ;fn 'kkjhfjd fodykax gks rks fVd ¼½ djsa (If any Physically Handicapped tick ¼½

15- ;fn vYila[;d gks rks fVd ¼½ djsa (Whether if Minority then tick ¼½

16- lkekftd fLFkfr % dsoy mi;qDr ckDl esa fVd ¼½ djsa (Social Status, Please tick ¼½ in the appropriate

box) HkwriwoZ lSfud (Ex-Servicemen) ;q) fo/kok (War Widow ykxw ugha gksrk (Not applicable)

17- /keZ% dsoy mi;qDr ckDl esa fVd ¼½ djsa (Religion, Please tick ¼½ in the appropriate box)

fgUnw (Hindu) eqfLye (Muslim) bZlkbZ (Christian) fl[k (Sikh) tSu@ckS) (Jain/Buddhist)

ikjlh (Parsi) ;gwnh (Yahudi) vU; d`i;k Li"V djs (if other, mention)

18- oSokfgd fLFkfr dsoy mi;qDr ckDl esa fVd ¼½ djsa (Marital Status, Please tick ¼½ on appropriate box)

fookfgr (Married) vfookfgr (Unmarried)

19- jkstxkj fLFkfr dksM % dsoy mi;qDr ckDl esa fVd ¼½ djsa
(Employment Status, Please tick ¼½ in the appropriate box)

csjkstxkj (Unemployed) jkstxkj;qDr (Employed)

,e-;w-,e-Vh-fu;fer dehZ (MUMT Regular Employee)

20- Nk=o`fRr dk fooj.k ;fn izkIr dh tk jgh gks (Details of scholarship being received if any) :

¼d½ jkf'k okf"kZd (Yearly Amount) ¼[k½ ljdkjh fMikVZesaV (Government Department)

¼x½ ikfjokfjd okf"kZd vk; (Annual income of the family)

(ii)
21- vko';d vgZrk,a tks vkidks ikB~;Øe ds fy, ik= cukrh gS Form No.
(Qualification, which makes you eligible for the programme )

vgZrk eq[; fo"k; mRrh.kZ djus dk o"kZ Js.kh izkIrkadks dk izfr'kr

(Qualification) (Main Subjects) (Year of Passing) (Division) (Percentage of
marks obtained)

n'keyo iz;ksx u djsa

(Dont' use
decimal value)

vkosnd }kjk ?kks"k.kk

eS] ,rn~ }kjk ?kks"k.kk djrh@djrk g¡w fd eSaus bl dk;ZØe ds fy, ik=rk laca/kh 'krksZ dks i<+&le> fy;k gS] ftlds
fy;s eSa izos'k ysuk pkgrk@pkgrh g¡wA esjs ikl bl ikB~;dze ds fy, U;wure ;ksX;rk gS vkSj eSaus bl laca/k esa vko';d lwpuk ns
nh gS A ;fn buesa ls dksbZ lwpuk xyr ikbZ tk,] rks fo'ofo|ky; dks vf/kdkj gksxk fd fdlh Hkh le; esjk izos'k jn~n djs nsa
vkSj ml fLFkfr esa] eSa nh xbZ fdlh Hkh Qhl dh okilh dk Hkh gdnkj ugha jgw¡xk@jgw¡xh A eSaus foojf.kdk esa fn;s x;s fo'ofo|ky;
ds fu;e /;ku ls i<+ fy, gSa A budks Lohdkj djrk@djrh g¡w vkSj Hkfo"; esa buds fo"k; esa dksbZ Hkh fookn ugha
mBkšxk@mBkšxh A
DECLARATION BY THE APPLICANT
I, declare that I have read, understood and accept all the terms and conditions related to the eligibility for the
admission. I also declare that the information provided by me are true and correct. If any information is found incorrect
or misleading, the University will have right to cancel my admission at anytime and stage and I will not be eligible for
refund of fees paid by me.

fnukad Date :

layXu izfrfyfi ¼d`i;k fVd djsa½ List of enclosures (please tick) vkosnd ds gLrk{kj
1- ikliksVZ lkbZt QksVks ¼QkeZ ij layXu djsa½ Signature of Applicant
Passport size photo (attached on form)
2- tUe izek.k i= vFkok nloh d{kk dh vadlwph v/kksgLrk{kfjr
Age Certificate or attested photocopy of marksheet of class 10
3- lHkh izek.ki= ckjgoh d{kk dh vadlwph dh Nk;kizfr
Attested photocopies of all marksheets obtained class 12 onwards
4- LFkkukarj.k izek.k i= ¼ewy izfrfyfi½
Original Transfer Certificate (where applicable)
5- izoZtu izek.k i=
Original Migration (where applicable)
6- tkfr izek.k i=
Caste Certificate (where applicable)
7- ewyfuokl izek.k i= Registrar
Domicile Certificate (where applicable) Seal and Signature
8- 'kqYd tek djus dh jlkhn] Mh-Mh-@psd ¼ewy izfr½
Fees details receipt, D.D./Cheque (Original)

Note : Only filled application form must be submitted to MUMT, Maharishi Road, Mangala,
Bilaspur 495001.

jlhn RECEIPT
vkosnu Øekad (Form No.)............................... o"kZ (Year)............................
Received application form and Sum of Rs. ................................... in cash/Cheque/DD No/Online Payment ......................................

dated..........................form Mr./Mrs./Miss........................................................................................for admission ............................

Date : Signature : ..................................................

Place : Name : ........................................................

(iii)
 MAHARISHI UNIVERSITY OF MANAGEMENT & TECHNOLOGY
Maharishi Road, Mangla, Distt, Bilaspur, Chhattisgarh-495001
APPLICATION FOR ENROLLMENT TO THE UNIVERSITY
Details of fee deposited

1. Name of the applicant (In English)

(In Block Letters)
(Female Students Must write Miss or Mrs. as the case may be)
2. Date of Birth (In figures) Mob. E-mail
3. Age on 1st January of the Year In which the Admission is sought .............. Year ..... Month ........... days
4. Whether belongs to scheduled Caste/Scheduled Tribe/OBC Yes/No (Strike out whichever is not
applicable)
5. Whether belongs to the category of the Defense Personnel for which reservation is approved by the
Government of India? Yes/No (Strike out whichever is not applicable)
6. Father's Name ......................................................... Mother's Name ............................................................
Husband's Name .....................................................................................
7. Place of permanent Residence .......................................................................................................................
........................................................................................................................................................................
8. Local Address .................................................................................................................................................
9. Examination passed prior to admission in the University ...............................................................................
University/Board .............................................................................................................................................
Year ........................... Roll No. ....................... Marks obtained .............. Max. Marks ......Percentage .........
10. Whether Enrolment Number has already been assigned by this University ? If so, please Indicate the
Enrolment Number ...................
Date ............................... Signature of the Applicant

PARTICULARS OF REGISTRATION
(To be filled in by the University)

Course ................................... Class ............................... Date of Admission ............................................

Certified that the entries above have been verified from the documents produced by the applicant.

To be filed in by the registrar's Office

Enrolment No. .....................................
Registrar
1. Migrated to ....................................................................................................................................................
2. University Examination taken Year Roll No. Result Signature of the Asst. Registrar (Exam)
(I) .................................................. ............ .................. ............ ........................................................
(II) .................................................. ............ .................. ............ .......................................................
3. Date of leaving ................................................................................................................................................
4. Migration Certificate No .................. Dated .............. issued for joining the ....................University/Institution.

Enrolment No. ...................................... revived vide order dated ................................................................................

Registrar
(iv)
 MAHARISHI UNIVERSITY OF MANAGEMENT & TECHNOLOGY
Maharishi Road, Mangla, Distt, Bilaspur, Chhattisgarh-495001

Examination form FOR ---------- SEMESTER (CANDIDATE ONLY) Previous Roll No. -----------------.
(Payment should be made by DD in favour of Registrar, Maharishi University of Management and Technology Payable at Bilaspur)
Application for admission to 1st/2nd/3rd/4th/5th/6th Semester Examination held at -------------------- (Please tick(/))

Examination Fee
Name of the Associate Institute & Code ...............................
Roll Number ..........................................................................
Enrollment No ........................................................................

To,
The Registrar,
Maharishi University of Management & Technology
Mangla, Distt. Bilaspur, Chhattisgarh-495001

Sir,
I beg to apply for admission to________ Semester Examination of ________ (Program Code) of the
University to be held in ___________________ the Examination Fee of Rs. ______________ (Rupees ____
____________) is sent herewith vide DD No. _____________________ dated ________________ drawn on
____________________ (name of the Bank) and my particulars are as under:
1. Name of the Candidate
Mr./Miss/Mrs.
(This must Correspond with the name written on the Enrollmenet Card)

2. Father's Name shri

3. Mother's Name Smt.

4. Male/Female M/F 5. Date of Birth Day Month Year

6. Address for Correspondence

7. Year of Admission
to the Course Month PIN CODE
8. Particulars regarding Previous Semester Examination
Roll No. ............................... Examination held in .....................................................................
Result : Pass/Unsuccessful/Reapper in paper ........................................................................
(Mention paper Nos.)
9. Full Name of the Examination .....................................................................................................................

Paper No. Name of the paper

Certified that the applicant bears good moral character.

......................................................................................... .......................................
Controller of Examination Signature of Candidate
(v)
 MAHARISHI UNIVERSITY OF MANAGEMENT & TECHNOLOGY
Maharishi Road, Mangla, Bilaspur, Chhattisgarh- 495 001

ADMIT CARD

(To be filled in by the candidate)

1. Name of the Candidate : .......................................................................

2. Enrolment No. : .......................................................................

Affix passport
size photographs
3. Name of the Course name : .......................................................................

4. Semester : .......................................................................

5. Examination to be held in year : .......................................................................

Signature of the candidate

(To be filled in by University Exam Department)
Roll Number Examination Centre

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

6. Name of paper
1 ............................................................................. 2 ......................................................................

3 ............................................................................. 4 ......................................................................

5 ............................................................................. 6 ......................................................................
Controller of Examination Registrar

Instructions:
1. Students are required to carry this admit card along with the Enrolment card with him/her on the day of the
Examinations.
2. Students are required to produce the admit Card/Enrolment Card at the time of entry in the Examination Hall
or on asking by the invigilator at any time during the course of the Examination.
3. In case a student is found using unfair means during the course of Examination, he/she is liable to
disciplinary action as per rules of the University.
4. Students are required to observe silence during the course of the Examination.
5. Students are required to report at the Examination Centre half an hour before the Commencement of the
Examination.
6. Taking of electronic devices like cell phone, calculators etc., in the Examination Hall is not allowed.
7. No candidate should leave the Examination Hall before the expiry of half an hour and without properly over
the answer book to the Invigilator-in-Charge.
(vi)
 MAHARISHI UNIVERSITY OF MANAGEMENT & TECHNOLOGY
Maharishi Road, Mangla, Bilaspur, (C.G.)-495001

vuqØekad------------------------------------------
¼mifLFkfr if=dk ,oa laf{kIr vkosnu i=½
ukekadu Øekad--------------------------------

dsUnz dk uke ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

dsUnz Øekad ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
ijh{kk dk uke ---------------------------------------------------------------------------- eq[;@iwjd@,-Vh-ds-Vh- ijh{kk ------------------------------------------------------
Jh@Jherh@dqekjh ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
vkRet@vkRetk --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
iwjk irk ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
¼vadlwph dh Nk;kizfr rFkk gLrk{kj izekf.kr djkus ds ckn vkosnu i= izLrqr djsa½
ijh{kk ds fo"k; Nk;k fp=
¼ikliksVZ lkbZt½
1-
2- ijh{kkFkhZ ds gLrk{kj
3- ikliksVZ lkbZt
¼izkpk;Z@foHkkxk/;{k@ijh{kk dsUnz izHkkjh½ QksVks fpidk,a
4- izekf.krdrkZ ds gLrk{kj lhy lfgr
5-
6- dqylfpo

ijh{kk dsUnz esa mi;ksx ds fy, mifLFkfr @ijh{kk dsUnz

Øekad fnukad fo"k; lewg ;k fo"k; mRrj ijh{kkFkhZ ds gLrk{kj ijh{kk Hkou ds lacaf/kr
iqfLrdk ¼uhps n'kkZ;s x;s
¼iz'u i= Øekad lfgr½ LFkku esa ijh{kk Hkou fujh{kd ds gLrk{kj
Øekad esa izR;sd iz'u&i= ds
fnu fy;s tkosa ½

(vii)