Appl. Form No. …………………. Scholar No.

Maharaja Ranjit Singh College

of Professional Sciences
NAAC accredited B++, UGC recognized 2(f) & 12 (B)
Approved by Govt. of M.P., AICTE New Delhi, Affiliated to DAVV, Indore & RGPV, Bhopal
Hemkunt Campus, Khandwa Road, Indore-452001 (MP)
Phone: 9926003874, 9977539505, 7024172241
Website: www.mrscindore.org • Email: [email protected]

Application Form …………………

FOR OFFICE USE ONLY
Paste 1 Passport
Registration No. ………….… Receipt No. …………...Date….……...…. Size colour
photograph and
Fee paid Rs……………..……Receipt No. ………………Date…………. attach 3 additional
photographs of the
Cash /DD/Chq. No/Online Payment …….……………………………. of the applicant

Date …………………Bank Name………………………………….……

Digilocker Id:____________________ ABC Id:__________________

Please attach:
Mark sheet Photocopy Original Original Certificate MP Resi. NRI
Class X Class XII TC Migration Eligibility SC/ST/OBC Character Proof Sponsorship

Year I II III

B.Com.__________________ B.A.________________ B.Sc.________________

BBA_________________ BCA_______________
Category:
Differently Minority
General SC ST OBC
Abled Muslim Jain Sikh Buddhist Any Other___________

1. Name (in English) (Capital Letters) ………..…………………………………………………….

uke ¼fgUnh½………..……………………………………………………………………………….
Blood Group ……… Mob.(Linked with Aadhaar) …………..……...………Email …..………………
Student Aadhar No .………………………….. Student Samagra ID ……………………………....
Date of Birth Age as on 01.07.2023, Years……….. Months…..…..

2. Father’s Name………………………..…..……………. Mob. …………………….. ………..…….

firk dk uke ¼fgUnh½………..…………………..………… Occupation ………………………...…
Mother’s Name…………………..……............…………. Occupation…………………………….
ekrk dk uke ¼fgUnh½………..…………………………… Mob.……………………………………
Local Address ……………………………………….……………………………………………....
…………………………………………………………… Landline No……………...………...…..

Student’s Signature …………………… Parent’s Signature …………………..

 Permanent Address…….………………………………………………………………....…….……
…….………………………………………………………….…………….………………………..
Ph. (with STD code) (O)…………………………...…….(R)……………...…….….….…………..
3. Bank Name: ………………………….….. Bank Branch:……………...……...……………………
Account No.:…………………..…….…..IFSC Code:……………………......…………………….
4. Is the applicant resident of M.P.: Yes  No  If not, of which place? ……………(attach Domicile)
5. Place of Birth…………………… Dist………..……..State………..Nationality…………………...
6. Bus Facility: Yes  No  Nearest Stop ……………..………………………………………..
7. Local Guardian’s Name…………………….……………Relation with applicant………...……….
Address………………………………….………………………..………………………………….
Contact No (Res.)………….…….………….…Mobile
No.….…...…..……..……………..……….
8. Educational Qualification (attach photocopy of Mark Sheet of each exam passed)
Div.
Name of Year of Board / Name of School / Name Marks
Roll No. with Remark
the exam Passing University College of City Obtained
%
10th
12th
I year
II year
9. If not appeared in any exam last year, give reason (attach Gap Certificate)
……………………………………………………………..………………………..…………
10. Extra curricular activities in which the applicant is interested:
a. Literary …………….. b. Cultural ……………...
c. Sports ………………. d. NCC/NSS/Others………………….
11. Is the applicant employed? Yes  No 
12. Has the applicant ever been convicted by the court of law/university or college or is any case
pending against him/her regarding indiscipline, use of unfair means, misconduct/or criminal
activities etc. Give separate details. Yes  No 
13. School/College last attended:
Name of Principal …………………………………………………………………………………
School / College Full Name…………………………………………………………………..........
Address…………………………………………………………..………...…Dist……………….
City……………………… State ………… Pin Code …….……….Contact No……..………......
14. Reference person (if any) …..………………………………………………………………………
15. I wish to be a member of ‘The MRSC Alumni’ Association of students after my graduation / Post
Graduation. I understand that a fee of Rs. 2,000/- is charged as Association fee. I agree to submit
the fee / or my fee may be taken from my Caution money.

DECLARATION & UNDERTAKING BY THE APPLICANT

I declare that all the entries in this form are made by me in my own handwriting and are true to the best of my
knowledge and belief. I accept to abide by the rules and regulations of the institutions. I promise that I will not
participate directly or indirectly in any activity which is indisciplinary, illegal or violent. In every such matter the
decision of the Principal/Directors will be acceptable to me. In case I do not abide by this agreement, my
admission from the college can be cancelled and I will be responsible for any disciplinary action taken against me.
In case of any wrong information or, entry on my part, if university takes any action, it will be my sole
responsibility; the college will not be responsible in any way.
I declare that I have taken admission for the full duration of the course and will not leave the course in between. If
I leave in between, I will be liable to pay all dues as per the College rules. I am not an employee or doing any other
regular course, anywhere.
I declare that I have not been involved in any activity of indiscipline. Misbehavior or use of unfair means in
examination in the past and that I have not hidden any fact regarding this. Any change of information given in this
form will be reported to the Principal / Office immediately. I also promise that I will fulfill the minimum
attendance as prescribed by the University failing which I can be debarred from the University Examination.
I assure that I was not involved n ragging earlier and I will not be involved directly or indirectly in any act of
ragging in future. I am aware of the laws regarding ragging and if found guilty of ragging, I am liable to be
punished under the law. I know that any incidence of ragging FIR will be filed with the local police authorities.
I will not use mobile phones during college teaching hours, nor I will be involved in illegal SMS, MMS traffics.
I understand that if anything is found to be false in my statement I will be expelled from the college.

Place………………………
Date ……………………… Students Signature

DECLARATION AND UNDERTAKING BY THE PARENTS/ GUARDIAN

It is certified that the information given by my son/daughter/ward in this admission form is true and I will
be solely responsible for his/ her activities and will pay attention towards his/ her progress. I will be
responsible for the payment of his/ her college fee and dues. My son /daughter/ ward will fulfill the
minimum attendance as required by the university rules failing which he/ she will not have any right to
appear in the examination.
I am aware of the law regarding ragging as a cognizable offence and shall abide by the punishment
given out to my ward in case / he/she is found guilty of ragging.
Place……………………… Parents/Guardian
Date ……………………… Signature

Student Information
Course Code Gender
Year of Passing 12th /UG Blood Group
12th/UG Roll No. Category
Board / University Minority
Date of Birth Marital Status
Last institute Attended Address
Result Father's Name
Marks Obtained Mother's Name
Total Marks Total Annual Income
Medium State
Subject Group Country
Additional Subject Pin
Name Mobile No. 1
Last Name Mobile No. 2
Samagra ID Aadhar No.
 Anti Ragging Committee
Morning Sift Noon Shift
1. Dr. Manoj Joshi 98260-92030 1. Dr. Pushpendra Dubey 97542-20781
2. Dr. Mandip Gill 99816-12347 2. Dr. Sheetal Bhasin 93032-37830
3. Dr. Mitesh Choudhary 94254-79738 3. Prof. Shifa Goyal 99267-78733
4. Prof. Mahima Jain 98260-37340 4. Prof. Praveen Sharma 98934-49056
5. Dr. Geeta Saneja 94253-47198 5. Dr. Mukesh Patidar 98263-77409
6. Dr. Nilesh Mandloi 98930-70366 6. Dr. Predeep Purey 98267-03505
Dr. Anand, Principal Mo.: 98267-80505 Dr. Ira Bapna Director Mo.: 98267-20505

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OUR COURSES
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email screenshot
[email protected]
with Student Name,
Father Name, Class,
Scholar No., Mobile No.
UPI NO / UTR NO /
RRN NO, Deposit Date
and attach a copy of fee
acknowledgement.