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Jai Narain Vyas University, Jodhpur: Candidate Registration Form (010) Department of Civil Engineering

Gaurav Verma has submitted a candidate registration form for the B.E. degree program at the Department of Civil Engineering of Jai Narain Vyas University for the 2016-2017 academic session. The form provides his personal details like name, father's name, date of birth, address, category, academic qualifications and subjects. It also includes an undertaking signed by Gaurav stating that he will abide by the rules and regulations of the university and bear individual responsibility. The completed two page form was submitted on July 14, 2016 to register for the graduation program.

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Jitendra Meerwal
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47 views2 pages

Jai Narain Vyas University, Jodhpur: Candidate Registration Form (010) Department of Civil Engineering

Gaurav Verma has submitted a candidate registration form for the B.E. degree program at the Department of Civil Engineering of Jai Narain Vyas University for the 2016-2017 academic session. The form provides his personal details like name, father's name, date of birth, address, category, academic qualifications and subjects. It also includes an undertaking signed by Gaurav stating that he will abide by the rules and regulations of the university and bear individual responsibility. The completed two page form was submitted on July 14, 2016 to register for the graduation program.

Uploaded by

Jitendra Meerwal
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Print Date & Time : 7/14/2016 11:37:00AM

JAI NARAIN VYAS UNIVERSITY, JODHPUR


Candidate Registration Form
SESSION : 2016 - 2017

(010) DEPARTMENT OF CIVIL ENGINEERING


Registration No. : J16U505018

Degree : B.E.

Applying For : GRADUATION

Registration Date : 14/07/2016

Form No. : DCE00278

Qualifying Exam Roll/Form No. :5025680


1. Name of the Candidate (

Enrollment No. :NA

(IN BLOCK LETTERS) :

GAURAV VERMA
Name of the Candidate (

(IN HINDI) :

2. Father's Name (

(IN BLOCK LETTERS) :

MR. PREMRAJ VERMA


Father's Name (

(IN HINDI) :

3. Mother's Name (

(IN BLOCK LETTERS) :

MRS. KANTA VERMA


Mother's Name (

(IN HINDI) :

RAJASTHAN

4. Date of Birth :

07/06/1999

5. Domicile :

6. Gender :

MALE

7. Res. Category :

8. Category :

SC

9. Caste Name :

BAIRWA

10. Income Tax Payer :

NO

11. Aadhar No. :

603996928927

12. Nominee Name/Relation :

PREMRAJ VERMA

13. Is Working? :

NO

14. Company Name :

NA

HINDU

17. Email ID :

[email protected]

19. Nationality :

INDIAN

15. Other Category :


16. Religion :

18. Do You Belong To Minority Category? :

NO

20. Have You Taken No Objection Certificate From (SP) (Optional) :

NO

21. Address

ENGLISH

22. Medium
Permanent Address

Address of Correspondence

Address :
PLOT NO.16 SHYAM NAGAR BEHIND
SHANI MANDIR

Address :
PLOT NO.16 SHYAM NAGAR BEHIND
SHANI MANDIR

District :

District :

Pin :

SAWAI MADHOPUR
322001

Pin :

Photo of Candidate

SAWAI MADHOPUR

Signature of Candidate

322001

Phone :
Mobile :

9660106076

Unique Identification Details


23. 10th Marksheet Sr. No. :

0434221

24. 10th Roll No. :

0821032

25. 10th Passing Year :

2013

26. 12th Roll No. :

1631027

Last Submit Date & Time ( 7/14/2016 11:36:41AM) IST

Last Updated Date & Time ( 7/14/2016 11:36:41AM ) IST

Page 1 of 2

Print Date & Time : 7/14/2016 11:37:00AM

27. Whether you were punished for any offense / unfair means committed by you in the previously attended or the
present institution (If yes, give details ) :
28. Weightages Claimed :

29. Academic Record :


S. No. Examination Passed

Year

Max
Marks

Percentage/ ExamStream
Grade

Obt.
Marks

Matriculation

2013

600.00 441.00

73.50%

Intermediate

2015

500.00 411.00

82.20%

Subjects

Board/University

Rajasthan Board of
Secondary Education,
Ajmer-305 001.
Physics Chemistry
Mathematics

Rajasthan Board of
Secondary Education,
Ajmer-305 001.

30. Subject Details :

Compulsory subjects
1

--NA--

List of subjects/Combination and their preferences.


S. No. Subject Preferences

Preference

Civil Engineering

NOTE: Mark the number of documents ( Photocopy/Xerox) attached by the Candidate during form submission to the college :
(a)

Xth Marksheet

(b) Xth Certificate.

(c) XIIth Marksheet.

(d)
(g)
(j)
(m)

Last Exam Passed Marksheet


Domicile (for other state)
Certificate for Vert./Caste Category
Migration Certificate

(e)
(h)
(k)
(n)

(f) Signature
(i) Certificate for Horz./Reservation Category
(l) Character Certificate
(o) Gap year Certificate

Photograph
Certificate for Kashmiri Migrants.
Transfer Certificate
Income Certificate

(p) Ward of University(if Applicable)


Undertaking
1. /
/ |
2. / |
3. / ,
/
/ |

4. / / |
5. / / 100%
/ 75% / |
6. , / / |
7.

|
/
/ | / |
/ / |

Dated :

Signature of the Applicant him / herself

Signature of Parent's/Guardian
Last Submit Date & Time ( 7/14/2016 11:36:41AM) IST

Last Updated Date & Time ( 7/14/2016 11:36:41AM ) IST

Student Receipt
Registration No. : J16U505018

Registration Date : 14/07/2016

Print Date & Time : 7/14/2016 11:37:00AM

Form No. : DCE00278

College Name : (010) DEPARTMENT OF CIVIL ENGINEERING


Degree :

Receiver's Signature

B.E.
Last Submit Date & Time ( 7/14/2016 11:36:41AM) IST

Last Updated Date & Time ( 7/14/2016 11:36:41AM ) IST

Page 2 of 2

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