Scribd
Upload
2K views4 pages

Ijh (KK Vkosnu I Ijh (KK Vkosnu I Ijh (KK Vkosnu I Ijh (KK Vkosnu I Ekg Ekg Ekg Ekg

This document appears to be an application form for admission to a government degree college's examination. It requests information such as the applicant's name, father's name, address, mobile number, examination fees paid, and details of previous examinations. The applicant is also required to declare their attendance and agree to abide by the college rules. At the bottom, spaces are provided for signatures of the applicant, parent/guardian and a verifying officer.

Uploaded by

VEERENDRA KUSHWAH
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
2K views4 pages

Ijh (KK Vkosnu I Ijh (KK Vkosnu I Ijh (KK Vkosnu I Ijh (KK Vkosnu I Ekg Ekg Ekg Ekg

This document appears to be an application form for admission to a government degree college's examination. It requests information such as the applicant's name, father's name, address, mobile number, examination fees paid, and details of previous examinations. The applicant is also required to declare their attendance and agree to abide by the college rules. At the bottom, spaces are provided for signatures of the applicant, parent/guardian and a verifying officer.

Uploaded by

VEERENDRA KUSHWAH
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
You are on page 1/ 4

'kkldh; deykjktk dU;k LukrdksÙkj ¼Lo’kklh½

Lo’kklh½ egkfo|ky;] Xokfy;j ¼e0iz0½


Tkhokth fo-
fo-fo-
fo- ukekadu@iath;u dz- ijh{kk vkosnu i= vuqdzekad ----------------------------------
¼ijh{kkFkhZ dk fo-
fo-fo-
fo- esa ukekadu@iath;u ekg---------------------
ekg--------------------- ijh{kk dk
dk uke--------------------------------
ugha gksus dh n’kk esa mldh vad lwph Category – Regular/Ex-Stud./ATKT
jksd yh tkosxh½

ijh{kkFkhZ dk ¼vaxzt
s h o.kkZ{kjksa es½a iwjk uke ikliksVZ lkbt
firk dk ¼vaxzt s h o.kkZ{kjksa es½a iwjk uke uke o vuqØekad
Nik QksVks
i= O;ogkj dk irk ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

tUe fnukad vk;q Ok"kZ VsyhQksu@eksckby

ijh{kk esa lfEefyr gksus okys iz’u&i=ksa ds dzekad ,oa iz’u&i=ksa ds 'kh"kZd ikB~;dzekuqlkj HkjsAa dksM dzeka
ekad HkjsAa
¼ ½ 1-------------------------------------------------------------------------------------- ¼ ½ 2--------------------------------------------------------------------------------------
¼ ½ 3-------------------------------------------------------------------------------------- ¼ ½ 4--------------------------------------------------------------------------------------
¼ ½ 5-------------------------------------------------------------------------------------- ¼ ½ 6--------------------------------------------------------------------------------------

Ikjh{kk 'kqYd dk fooj.k


ijh{kk
ijh{kk 'kqYd jkf’k Hkqxrku dk fnukad INB Reference No.

xr o"kZ dh ijh{kkvksa dk fooj.k


ijh{kk dk uke cksMZ@fo-
fo-fo-
fo- ijh{kk dk [email protected]
a xr o"kZ dh ijh{kkvksa esa fVIi.kh
o"kZ ATKT dk fooj.k
bUVjehfM,sV ¼12th ½
izFke lsesLVj
f}rh; lsesLVj
r`rh; lsesLVj
prqFkZ lsesLVj
iape lsesLVj
"k"Ve lsesLVj

Nk=k }kjk mifLFkfr lEcU/kh ?kks"k.kk&i=

eSa dqekjh@Jherh------------------------------------------------------------------------------------------------iq=h@iRuh@Jh------------------------------------------------------------------------------------------------
fu;fer Nk=k d{kk--------------------------------------lsD’ku---------------------------------------------- ;g ?kks"k.kk djrh gw¡ fd eSa egkfo|ky; esa fu;fer d{kkvksa esa mifLFkr
jgw¡xh rFkk l=kar rd thokth fo’ofo|ky; Xokfy;j ds fu;ekuqlkj mifLFkfr iwjh j[kuk esjk nkf;Ro gksxk] ;fn eSa ,slk u dj ldwa rks
okf"kZd ijh{kk esa lfEefyr gksus ls egkfo|ky; eq>s oafpr dj nsxk rFkk blesa eq>s dksbZ vkifÙk ugh gksxhA vkosnu dk fooj.k iw.kZr% lR; gS
rFkk egkfo|ky; ijh{kk ds fu;e] vkns’k ,oa fu.kZ; eq>s ekU; gksx a As eSa vU; fdlh Hkh ijh{kk esa lfEefyr ugha gks jgh gw¡Aa

firk@vfHkHkkod ds iw.kZ gLrk{kj ijh{kkFkhZ ds iw.kZ gLrk{kj

fnukad------------------------------------------------- uke ------------------------------------------------

1
1 1
'kkldh; deykjktk dU;k LukrdksÙkj ¼Lo’kklh½
Lo’kklh½ egkfo|ky;] Xokfy;j ¼e0iz0½
lR;kiu&izi= % lS)kfUrd ijh{kk
ijh{kk
Category – Regular/Ex-Stud./ATKT

vuqdzekad------------------------- --------------------------------------------------------
---

ikliksVZ lkbt
ukekadu@iath;u dzekad--------------------------------------- uke o vuqØekad
Nik QksVks
ijh{kk dk uke--------------------------------------------------------------------
ijh{kkFkhZ dk uke--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
,

¼efgyk,¡ vius uke ds iwoZ dqekjh ;k Jherh tks Hkh gks vo’; fy[ks½a
firk dk uke------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
i= O;ogkj dk irk ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
eksckbZy ua0 --------------------------
--------------------------------------------
Ikjh{kk 'kqYd dk fooj.k
ijh{kk 'kqYd jkf’k Hkqxrku dk fnukad INB Reference No.

ijh{kkFkhZ ds vkosnu i= vfHkizekf.kr drkZ


Hkjrs le; ds gLrk{kj ¼f’k{kd vfHkHkkod½
gLrk{kj---------------
gLrk{kj--------------------------------------------
--------------------------------------------
Ukke--------------------------------------------------
Ukke--------------------------------------------------

ijh{kkFkhZ ijh{kk esa ysus okys fo"k; ,oa iz’u i=ksa dk iwjk uke ,oa miuke vkfn ¼ikB~;dzekuqlkj½ fy[ksa rFkk ijh{kk Hkou esa fnukad] mÙkj&
iqfLrdk dk dzekad ,oa vius gLrk{kj dh vkiwfrZ izfrfnu uhps ds dkWyeksa esa djsAa

¼fu/kkZfjr dkWye esa dzekuqlkj iz’u&i= vo’; HkjsAa ½


dz- ikB~;dze ds vuqlkj iz’u&i= gksus izkIr mÙkj&iqfLrdk Ikjh{kkFkhZ ds gLrk{kj oh{kd ds gLrk{kj o
iz’u&i= dk iwjk uke dk fnukad dk dzekad fnukad
1
2
3
4
5
6
7

vfHkizekf.kr
¼gL{rk{kj dsUnzk/;{k½

2
'kkldh; deykjktk dU;k LukrdksÙkj ¼Lo’kklh½
Lo’kklh½ egkfo|ky;] Xokfy;j ¼e0iz0½

ijh{kkFkhZ dk uke-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ijh{kk lu~ 20---------

izos’k i= ikliksVZ lkbt


uke o vuqØekad
¼eq[; ijh{kk gsrq½ Nik QksVks
,

Ukekadu@iath;u Øekad------------------------------------------------------------------------------------------------------------------------------------vuqØekad------------------------------------------------------
dqekjh@Jherh ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

vkRetk@iRuh --------------------------------------------
-------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------------------------
-------------------------------------------------------------------------------------------------
-----------------------

tks bl egkfo|ky; dh Nk=k gS] dks d{kk ------------------------------------------------------------------------------------------------------------------------------------


------------------------------------------------------------------------------------------------------------------------------------
dh ijh{kk esa lfEefyr gksus ds fy, bl dsUnz ij izo’s k fn;k tkrk gSA

Ikjh{kk ds fo"k;%&

1-------------------------------------------------------------------------------------------------------------------------

2-------------------------------------------------------------------------------------------------------------------------

3-------------------------------------------------------------------------------------------------------------------------

4-------------------------------------------------------------------------------------------------------------------------

5-------------------------------------------------------------------------------------------------------------------------

6-------------------------------------------------------------------------------------------------------------------------

ijh{kk fu;a=d

3
'kkldh; deykjktk dU;k LukrdksÙkj ¼Lo’kklh½
Lo’kklh½ egkfo|ky;] Xokfy;j ¼e0iz0½
vfr&vko';d
lsesLVj ijh{kk dh vadrkfydk gsrq
For Semester Exam. Marksheet ikliksVZ lkbt
uke o vuqØekad
Nik QksVks
ijh{kk dk
dk uke ------------------------------------------------------------ lsesLVj------------------------------------------------------------------
Name of Exam. ------------------------------------------------------------------------------------------------------------------------------------------------------
ijh{kkFkhZ dk uke -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
¼gkbZ Ldwy ekdZ’khV ds vuqlkj½
Name of Student -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
,

firk dk uke ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------


¼gkbZ Ldwy ekdZ’khV ds vuqlkj½
Name of Father -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
vuqdzekad ------------------------- ------------------------------------------------------------------------------------------------------------------------------
---

Roll No. -------------------------------------------------------------------------------------------------------------------------------------------------------

ukekadu dzekad -------------------------------------------------------------------------------------------------------------------------------------------------------

Enrollment No. -------------------------------------------------------------------------------------------------------------------------------------------------------


-

Js.kh jsxqyj@,Dl LVw


LVM
w Vsa @,-
@,-Vh-
Vh-ds-Vh ---------------------------------------------------

Category Regular/ Ex. Student/ A.T.K.T. ---------------------------------------------------

gLrk{kj ijh{kkFkhZ

Ukke-------------------------------------------------
-------------------------------------------------

d{kk-------------------------------------------------
eksckbZy ua0 ----------------------------------

You might also like