ENGINEERING COLLEGE, AJMER2 STUDENT ADMISSION FORM

Academic Session 20...20.... FOR OFFICE USE ONLY

Course: B.Tech / M.B.A /M.C.AJ M.Tech/ Ph.D Through: REAP/JEE(Mainsy CMAT/ 12h RMCAATIDirect /1.EEP . 4****************************************

(To be filled by student only) Branch.... .. GASISFS/TFWSEWS.. Merit No.. ..Cat. Wise Merit .. VEERING COLEGE

Name of Student (IN CAPITAL LETTERS)..

2 Name of Student (IN HINDI) .. ******

3. Father's Name... Please affix latest '*** **** passport size

photograph 4. Mother's Name ....

5. Name of Guardian with Relationship (If parents not alive).. ** '***"*"°

6. Occupation and Annual Income of Father/Guardian .... ************

7. Date of Birth 8. Nationality . ******* ****'*************** **** **********'****

9. Married/Unmarried.. ..10. Male/ Female.............I. Rural/ Urban. ******°° ****

12 Aadhar No..... ....13. Blood Group.. ***** 14. Admitted Under Category (GEN/ SC/ST/OBC/MBC/SBC/ TSP/TFWS/ EWS/ PH/KM/EX.Serv..

15. Sub Cast (Please specify Minority Group if any. ). 16. Competitive Exam passed for Admission 17. Address for Correspondence with Parents ..

***"*" ****'*** '**

Roll No... ... Merit No. .... *** ** ***** ******

****' *

District.. .. .. State... . Pin Code * 18. Parents Telephone No. (With STD Code )..... ****'***'***** . Mobile No.

19. Student Contact No. ... . 20. Student Email ID.. 21. Present Address of Student in Ajmer 22. Address of Local Guardian to be Contacted in Emergency

*****'******* ***°'*****'*

***********

*********************** **

....Pin Code..... Pin Code

Contact No. (Residence). Contact No. of Local Guardian ..

23 Name of the Railway Station nearest to Home Town for Rail / Bus Concession. *******"

24. Admitted in Counseling (First/ Second/ Internal Sliding/ Direct)..

25. Name of College (if Transferred from any other College)... **

26. Educational Qualification:-

No. of Passed as Name of the Subiect Percentage Attempt Regular /Private Year of

S.No. Examination Passing Board/Univ. 1. Secondary

2. Sr. Secondary

3. Diploma or Other

27. Any gap in Studies (Y/N) ... Period From ....... to .. Reasons...... *'********'***

28. For Insurance Purpose: Name of Nominee Relation Physical Handicapped (Y/N)

Signature of Student

DECLARATION BY THE APPLICANT

do solemnly affirm that the statements and information. furnished by me and also in the enclosures submitted are true. I realize that, if any information furnished there in is found to be false in material particulars. I shall be liable to criminal prosecution as well as to forgo my admission and discharged from the college, if already admitted.

I also undertake to pay the College, Hostel and other dues regularly.

I promise to abide by the rules & regulations of the College as well as those of the University concerning

examinations attendance. practical training etc. as present in force as well as those that may be made/ modified from time to time.

I also declare that:- (a) I have not been convicted for any criminal offence nor have bcen released on bail in connection with

criminal cases. (b) No case of criminal offence or moral turpitude is pending against me in any court of law. (c) No complaint of FIR has been lodged against myself by the University/ Principal of a constituent

College/ Afiliated College or by any other competent authority (d) I have not resorted to any act of indiscipline during the previoUs years.

Signature of the Applicant... ... Place.. Date...... **

Enclosure: Transfer Certificate/ / Migration Certificate/ Mark Sheet of qualifying examination/ High School Certificate for Proof of Age / Medieal Certificate/ Allotment Letter/ Cast Certificate / Bank Challan Copy/ Income Certificate ( For TFWS/ EWSy Aadhar Card/ Three envelopes of 6" x 4" size bearing address of correspondence with parents/ any other.

For Office Use Only

Category (For Fec): General/ SC/ ST/ OBC/ MBC/ SBC/ PH/ EX. Serv/ TSP/ KM/ /EWS/TFWws

Hosteller/ Day Scholar GAS /SFSs Male/Female

Course ......Ycar... . Branch .... ''****'**********'

Fee: College Fee Rs.... Hostel Fee Rs. .. ** ****''° '********

University Fee Rs... . Exam Fee Rs. .

Insurance Charge . . Any Other Fee Rs. *******

Received Rs... ... through DD/Cash/Challan/ Online vide Receipt No........ Dated .....

Note: Difference Amount (if GAS to SFS/College change / any ).. Name & Signature (from Account Section) ..

Note: If Branch change after Upward movement/ Internal Sliding ( Branch Name)...

Signature of Student

Name and Signature of Concern Staff Name and Signature of Coneerm Proctor

/Committee Convener