7/27/2019 B.ed,D.pharmacy Form

http://slidepdf.com/reader/full/beddpharmacy-form 1/1

 ……………………………………………………………………………………………………………………………………………………………………  

TIRUPATI GROUP OF INSTITUTIONSRatia - Sardulgarh Road, RATIA (FATEHABAD) HARYANA

Admission FormS. No.:---- Specimen Copy----- 

 Name:……………………………………………………………………… 

Father’s Name:…………………………………………….……………….. 

Mother’s Name:……………………………………………………………. 

Sex (Male/Female):………………………………………………………… 

Date of Birth:…..………………………… Category ……………………... 

Haryana Resi./Others:……………………. Religion.……………………… 

Address for Corres pondence:………………………………….……………………………………………… 

Village……………………………………………P.O:………………………………………………………. 

Distt:..……………………………………………State:………………………………………………………  

Pin Code…………………………………………Phone/Mobile No..…..………….…………........................

Courses: B. Ed. D. Ed. D. Pharm. Diploma in Civil Engg.

Diploma in Elect. & Comm. Engg. Diploma in Mech. Engg.

Diploma in Civil Engg. (Lateral Entry) Diploma in Mech. Engg. (Lateral Entry)

Diploma in Elect. & Comm. Engg. (Lateral Entry)

Educational Qualification:

Examination

Passed

Board/

University

Month &

Year

Reg. No. Subject

Studied

Marks Obt/

Max. Marks

% age

Matric

Senior Secondary

Graduation or anyEquivalent

Qualification

Post Graduation or any Equivalent

Qualification

Any Other 

DECLARATION:

I hereby solemnly affirm and declare that information given in admission form is correct and true to the best of my knowledge and belief. I further declare that I have not concealed any information & eligible for admission

as per eligibility conditions and policy declared in the prospectus issued by Haryana Govt./C.D.L.U., Sirsa/ NCTE, New Delhi/ SCERT, Gurgaon/HBSE, Bhiwani/Directorate of Technical Education, Panchkula/HSBTE,

Panchkula/PCI & AICTE New Delhi. If at any stage any information provided/given by me is found false andincorrect my admission in the concerned course shall stands cancelled and legal proceedings may initiated

against me as per the court of law.

Signature of Student Date:……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………… 

For Of fi ce Use Only 

Checked By: Signature with seal of 

Principal/Chairman

 Affix latest Passport 

 size photograph in

the box