For Office Use Only: Roll No: ........................ Journal No: ........................ Deposit Date: .......................

Khalsa College for Women, Ludhiana

Civil Lines, Ludhiana. Phone: 0161-2420987

Admission Form (2023-24) Application / Form No: 12482-5992

Class Name: BA Sem-III Category: General

UNI/PB.GOVT APPLICATION ID:

PERSONAL DETAILS Applicant ID: 220300007301
Applicant's Name: PALAK JAIN
Father's Name: TARUN KUMAR JAIN Mother's Name: VIBHA JAIN
Father's Occupation: Business/Self Father's Mob: 9417008466
Employed
Annual Income: Above 5,00,000 Gender: Female
Caste: General Religion: Jain
Guardian's Name:
Date of Birth: 05-Sep-2004 Blood Group: O+
Mobile No: 9417008466 E-Mail ID: [email protected]
Paste your
Registration No: Medium: English recent
passport size
Aadhar No: 823846862913 Parking: Motorcycle/Scooter unattested
Freeship Card No: photo here
PERMANANT ADDRESS
Area Type: Urban Nationality: INDIAN
Address Line 1: 2095/8A Adarsh Street Shiv City / Village: Ludhiana
Puri, Near Indian Bank
District: Ludhiana State: Punjab
Country: India PIN Code: 141008
Vaccination: Yes - 2 Benf.Ref.ID: 28488628685175

MISCELLANEOUS
Gap Case: No Criminal Case: No
Punjabi Passed In Matric: No Last Session: 2022-23
Last Class Attended: BA Sem-I Last College 220014
Roll_No:

SUBJECT PREFERENCE
1: Computer Science 2: English 3: English-Literature
4: Music Instrumental 5: Punjabi
LOWER EXAM DETAILS
Exam Name Board / Univ. Year- Roll No Obt. Max. %age
Month Marks Marks
10+2 Arts CBSE, DELHI 2022-05 13668086 349.00 500 69.80
BA Sem-I PB UNI, CHANDIGARH 2022-12 0 0.00 0 00.00
BA Sem-II PB UNI, CHANDIGARH 2023-05 0 0.00 0 00.00
MARKS & WEIGHTAGE DETAILS
Marks in Lower Exam: 0.00 / 0 Marks in Related Subject: N/A
Has Honours Subject / Class: No NCC/NSS Level: /
Roll of Honour: No University Colour: No
Youth Festival Position:
Continued on page 2 ...
 KCWLDH / 220300007301 / 12482-5992 / PALAK JAIN / BA Sem-III / GN / Page 2

BANK ACCOUNT DETAILS

Bank Name:
Bank Account No: Bank Branch:
IFSC Code: MICR Code:

DECLARATION BY APPLICANT
1. Certified that the particulars given above are correct to the best of my knowledge.
2. I have noted that it is compulsory to attend 75% lectures and secure 25% in aggregate in Pre-semester exams to
quality for the final examimaton.
3. I am aware that the Principal has the right to detain my roll no., if I do not fulfil the conditions required to be eligible for
appearing in the final exam.
4. Certified that I am applying with the permission of my Parents/Guardian.
5. Certified that I have not been disqualified by any board/university.
6. Certified that I am not seeking admission in any other recognized institute at the same time.
7. I pledge to bear good moral character and will not participate in any anti-social activities.
8. Certified that in case a board/university refuses to grant me admission, I will not lay claim against the college.

Applicant's Signature
DECLARATION BY FATHER / GUARDIAN
1. I have read all rules and regulations in the prospectus and will abide by them.
2. I will pay all due fee and funds of my son / daughter.

Father/Guardian's Signature

ADMISSION COMMITTEE RECOMMENDATIONS

Registered with Panjab Uni. Chandigarh: Yes Type: Old Student of this Fee Concession: YES / NO
College

Member 1 Member 2

It is certified that the applicant is found to be eligible for admission and is recommended to be admitted as per specified
merit / category. I have checked all documents and merit.

Convener's Signature

Principal's Signature
(Tick the certificates attached)
* Attested photocopy of Date of Birth Certificate
* Four passport size recent photographs.
* Self Attested photocopy of DMC's of examinations passed from Matriculation onwards.
* Self Attested photocopy of Passing out Certificate of 10+2.
* Self Attested photocopy of SC/ST/BC/ any other reserved category.
* Self Attested photocopy of Character Certificate from the institution last attended.
* Self Attested photocopy of Gap Year Certificate (if applicable)
* Self Attested photocopy of Roll No. cum Registration No. of B.A.1 / B.Sc. 1/ B.B.A. I/ B.C.A. I/ B.Com I for students
seeking admission in II or III year or in any Post-Graduate class.
* Students from other university should submit migration certificate at the time of admission
* The students must bring their original documents at the time of admission.
* Self Attested photocopy of Aadhar Card.
Note: A student who is absent from the college for more than 10 days continuously (without leave or prior information)
shall find her name struck off from the college rolls. She shall have to seek re-admission with the permission of the
Principal.
 ANNEXURE - I, PART - I
UNDERTAKING BY THE CANDIDATE/STUDENT
1. I PALAK JAIN S/o. D/o. Mr./Mrs./Ms. TARUN KUMAR JAIN have carefully read the law prohibiting ragging and the
directions of the Supreme Court and the Central/State Government in this regard.

2. I have read a copy of the UGC Regulations on Curbing the Menace of Ragging in Higher Education Institutions, 20O9.

3. I hereby undertake that

- I will not indulge in any behavior or act that may come under definition of ragging.

- I will not participate in or abet or propagate ragging in any form.

- I will not hurt anyone physically or psychologically or cause any other harm.

4. I hereby agree that if found guilty of any aspect of ragging. I may be punished as per the provisions of the UGC
Regulations mentioned above and/or as per the law in force.

Signed on:06-07-2023 e-Mail: [email protected]

Signature: Mobile (Father):

Name: PALAK JAIN Mobile (Mother):

Mobile (Applicant): 9417008466

Address: 2095/8A Adarsh Street Shiv Puri, Near Indian Bank Ludhiana, District: Ludhiana, State: Punjab, PIN: 141008

ANNEXURE - I, PART - II
UNDERTAKING BY THE PARENT/GUARDIAN
I .................................................................. F/o, M/o, G/o PALAK JAIN have carefully read the law prohibiting ragging and
the directions of the Supreme Court and the Central/State Government in this regard as well as the UGC Regulations on
Curbing the Menace of Ragging in Higher Educational Institutions, 2009.

2. I assure you that my son/daughter/ward will not indulge in any act of ragging.

3. I hereby agree that if he/she is found guilty of any aspect of ragging, he/she may be punished as per the provisions of
the UGC Regulations mentioned above and/or as per the law in force.

Signed on: 06-07-2023

Signature:

Name: e-Mail: [email protected]

Address: Mobile: