NORTH-EASTERN HILL UNIVERSITY
HEADQUARTERS: SHILLONG - 793022, MEGHALAYA
Form No:-21120137 APPLICATION FORM Date:-08/08/2021
Session:-2021-2022
Applied Programs 2021-2022/B.A.LL.B(Honours) (Campus Location: Shillong).
Name of the applicant MARK RYAN SYIEMLIEH
Gender Male
Nationality India
Domicile of Meghalaya ? Yes
Father's Name Walter Nongkhlaw
Mother's Name Ester Syiemlieh
Permanent Address Lummawbah, Block II
shillong,Meghalaya,India
Phone/Mobile-9436994711,9863303791
PIN-793005
Email-nongkhlaw1976@gmail.com
Mailing Address Lummawbah, Block II
shillong,Meghalaya,India
Phone/Mobile-9436994711,9863303791
PIN-793005
Email-nongkhlaw1976@gmail.com
Guardian Details Name : Margret Syiemlieh
Address : Lummawbah, Block II
Relationship : Aunty
Mobile : 9863061484
Date of Birth 13/11/2002
Blood Group O+
Marital Status Single
Religion Christianity
Category ST
Are you Employed ? No
If yes, give the name of the organization
Whether graduated from colleges No
affiliated to NEHU?
Have you registered for any other No
courses in NEHU?
Payment Details :
Mode Of Payment : Online Transaction Id(ERP) : 1212711382
Amount : 400.0 Transaction Date : 07/Aug/2021
Educational Qualification
Examination Roll No School/Board/College Subject Year Division % of
passed /Univ. Marks
10th 20709 MBOSE English, Additional English, Mathematics, May2019 I 70.0
Science & Technology, Social Science,
Health & Physical Education
10+2 th 116387 MBOSE English, Alternatice English, Political Science, Aug2021 I 64.0
Economics, Geography, History
Degree
Post Graduation
Other
If applying under Quota, select the appropriate category-
Differently-Abled : No (If yes, Attach relevent documentary evidence)
Are you from educationally backward area? : No (If Yes, Attach relevent documentary evidence)
Whether you are outstanding sports women/men? : No (If Yes, Attach relevent documentary evidence)
Whether you are NSS candidate? :No (If Yes, Attach relevent documentary evidence)
Hostel accommodation required? No
Whether ex-servicemen?: No
Whether you are a foreign student?: No
Whether children of Indian workers in gulf countries? No
Whether Kashmiri migrant? No
Declaration by the Applicant
(a) I declare that the entries made above by me in the form are correct and true to the best of my knowledge. I am aware that if
any of the entries is found to be incorrect, my admission is liable to be rejected.
(b) I have read and understood all the provisions of admission and agree to abide by them. In the event of submission of
fraudulent, incorrect or false information or suppression or distortion of any fact like education qualification, marks, nationality
etc.I understand that my admission/degree is liable for cancellation.
(c) I further understand that my admission is purely provisional subject to the verification of the eligibility conditions.
(d) I also understand that application fee once paid is not refundable.
(e) After my admission, I undertake to abide by the rules of the University enforce from time to time and to submit myself to the
disciplinary jurisdiction of the Vice-Chancellor and other authorities of the University.
(g) I undertake that I shall not involve myself in ragging in any form. In case, I am found to be involved in ragging, the University
may take any action against.
I certify that I have read and agree to the North Eastern Hill University terms and conditions as given in the prospectus.
(Signature of the applicant)
