Sr. No. .
DESH BHAGAT GROUP OF INSTITUTES
Amloh Road, Mandi Gobindgarh (Punjab)
ADMISSION FORM
SESSION Note: This form is to be filled in by the student in capital letters only.
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Course _________________________________________________________________ Type of Course : Regular Name of the Student Tick the appropriate () Boxes Male NRI Sports Person Female Handicapped Urban S.C. Rural S.T. B.C. Gen. Distance
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Others __________________
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Date of Birth Fathers/Guardians Name Occupation Mothers Name State of Residence/domicile Mailing Address __________________________________________________________________ _________________________________________________________________________________
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Permanent Address__________________________________________________________________ ______________________________ Mobile ___________________________Ph. No. Parents Mobile ________________________________ Ph. No.
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E-mail Id _________________________________ Blood Group ______________________________ Do you need Hostel Facility :Yes No
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Qualifications Details:
Qualification
Main Subjects
Session
%age Marks/ Grades
Board/ University
University Regd. No./ Board Roll No.
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Nationality DELCARATION BY THE STUDENT AND PARENTS
1. 2. 3. 4. 5. I am responsible for the information given above by me and it is true to the best of my knowledge and belief and nothing has been concealed therein. I hereby agree to conform to all rules, acts and laws enforced by the University and the Institute. Further I, hereby undertake that if I disobey any of the rules or regulations of the Institute, then any disciplinary action may be taken against me, even to the extent of expulsion from the Institute. I know that at any stage of my course, if any, discrepancy is found in my testimonials / documents / eligibility by the University or any other Authority, the Institute will not be held responsible and I will own the responsibility. I hereby agree to pay the full fee of the course even if I discontinue at any time during the course, as I am fully aware that the seat vacated by me will be a loss to the Institute. I hereby agree to fulfill the 75% attendance condition and to clear the conditional examinations to make myself eligible in the final exams as per the University rules. Date :- ______________ Signature of Parents Signature of Student
DECLARATION FROM FATHER / MOTHER / GUARDIAN
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The particulars furnished by my son/daughter / ward in his / her admission form are true to the best of my knowledge and belief. I undertake and bind myself to pay by due date on behalf of my son/daughter / ward such fee / fines / charges etc. which the Institute may levy upon him/her from time to time and in the event of failure to perform this duty, the Principal of the Institute may take such action against my son/daughter / ward as he / she may deem fit. That I being the father/guardian of Mrs. / Ms. / Mr. _______________________ do undertake the entire responsibility of his/her good behavior and he/she will maintain proper discipline during his/her stay in the college and or Hostel. That I will pay any difference in college fee/ dues from time to time on account of enhancement. That the college authorities have explained to me about the eligibility criteria & status of the college regarding Punjab Govt. approval, AICTE approval and University affiliation etc. I am admitting my ward after thorough consideration and to my full satisfaction.
Date :- ____________________
Signature of Father/Mother/Guardian
FOR OFFICE USE ONLY
1. 2. Date of Form Submission : List of Original Certificates received : (a) Matric ________________ (d) (b) 10+2 _________________ (e) (c) Graduation _____________ (f) Migration ________________ Character ________________ Any other ________________ (Office Executive) (Univ. Coordinator)
(Admission Clerk)
(Coordinator) (Member of Admission Committee)
