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 Regional Institurte of Edurcation, Ajmer
B.Sc. B.Ld. Part-l (PCM Group)
Admission for Session 2018- l9
Provisionally Wait listed Candidates from UP State
Against One Vacant Seat in PWD Category
(Candidates in the list: 02)
State/ Cate- Total Remark
S No Appl_no norr no
tlT Name
llra-e
gory Score I
1 U. P, 2018000444 t1-7 6L S PARSH SAXENA GM 10.342

2 UP 2018019503 23t42 SHA LJA SAX E NA GM 70 188

Provisionally Wait listed Candidates for UP State

-fhree Vacant
Against Seats in OBC Category
(Candidates in the list: 06)
State/ Cate- Tota I Remark
5.No Appl_no norr no
UT Name gory Score 1
lr,rame
1 U.P 2018031814 26558 PRABHAKAR KU MAR YADAV OBC 65.988

2 U,P 2A18025547 26454 DEEPAK SINGH OBC 64 838

3 U-P 2018024121 z as++ lanorr vaonv oBc 64.642

4 U, P, 201801009 0 26481 lraxv' orvr OBC 64.63

5 U.P 20L804A129 291-95 HIMANSHI CHAU DHARY OBC 64 55

6 U,P 2 018007 0 34 26481 VAIBHAV YADAV OBC 64

Provisionally Wait listed Candidates for DL,HP,UK,CH & J&K States

Against Two Vacant Seats in OBC Category
(Candidates in the list: 09)
state/ Cate- Total Remark
5 No Ap pl_no Roll no Name I
[JT Name gorY Score

1 CHD 201801-251,2 1-9929 SHIVANGI YADAV OBC 54.1-21

2 H,P 2018032896 19841 VIBHAV DHIMAN OBC 53 621

3 DL 2018014632 29120 SHIVAM KATARIA OBC 53.192

4 UKD. 2 0180019 5 6 28487 CH ETNA BHATT OBC 52.85

5 DL 2018003921 29s67 MONIKA OBC 52.7 25

6 CHD 2018008 26 2 19999 NAMAN KU MAR OBC 49 23

1 Dt 2018041,461. 297 40 SH VANi KU MAR OBC 44.296

8 DL 2018011100 2811,6 RAKHEE ROY OBC 39 825

DL 2 0180 2 65 60 28916 KAP IL GOSWAMI OBC 38.933

Provisionally Wait listed Candidates for DL,HP,HR,PB,UK,CH & J&K States

Against One Vacant Seat in SC Category
(Candidates in the list: 05)
Cate- Total Rema rk
State/
S No Appl_no Roll no Name
UT Name gory Score 1

1 HP 201AO20474 32126 N ITIS H KUMAR SC 53 283

2 DL 2018074224 29051 DIBYOJYOTI ROY 5C 52 255

3 DL 2018038467 2927 5 M EDHANKAR SHEEL SC 51 058

4 HR 20L8021238 28922 KARAN 5C 50 033

5_. HR, . 2018034 69 29245 PREETI .SC 48.5 3 8

PaEe-7/l
 REGIONAL INSTITUTE OF EDUCATION. AJMER
(National Council of Educational Research & Training) Alllx
(NAAC accredited with A+ Grade lnstitution of NCERT) latest
photo
qi Sf srr cl
NCIERT
Performa for checking of original documents and depositing fees etc.
Session 20 -20
Programme : ...........................
Reg./Appl. No.........................

L Name of Student (In Capital letters)

2. Mother's Narne
3. Father/Guard ian's Name

4. Date of Birth
5. Category (GEN/OBC/SC/ST/PWD)
6. Aadhar Card No.
(A photocopy must be attached)
7. State from which you have been
selected for admission

8. Residence Address

Pin ..

9. Name of Home Town

10. Nearest Railway Station

11. Nearest Bus Station

(For of Railway/Bus Concession)

12. Are you employed ?

(lf employed, give the name &
address of the Employer)

I 3. Teaching Experience (Certifi cate

to be enclosed duly contersigned
by the Inspector of School/
District Education Offi cerlBDO)
14. Nan.re ofthe Board/University last attended
I5. Name ofthe Institution last attended.
16. In case you l.rave already been enrolled in the
MDS Urriversiry. Ajmer please rnention your
Enrolment Number

17. Whether Hostel accommodation is required? Yes / No

18. Whether Police verification certificate is enclosed? Yes./ No

19. Academic Records

MARKS Percentage
Examination Passed Year Division of marks Subject Offered
Maximum Obtained
obtained
Sr. Sec./lllter/+2

B. A./B.Com./B. Sc.

M,A /M.Com./M.Sc
B.Ed./B.T./L.T
M F,d

Other

Date : Full Signature of the student

P.T.O
 1

FOR OFFICE USE ONLY

Original documents have been checked by me and found correct. Self Attested/Attested copies of
necessary documents along with the Original Transfer Certificate/College Leaving Certificate/Relieving
letter/No Objection Ceftificate from the Organization/lnstitution last served/serving are enclosed ir the
original Application Form.

The student Ms.,Mr. reported in the

forenoon/afternoon of ........................... .

CHECKING OFFICER

Fees may be accepted/not accepted.

( ()NVtiNOR
HEAD OF DEPARTMENT/CHAIRPERSON ADMISSION COMMITTEE

PRINC I PAL

Hostel accomodation allorved/not allorved.

CHIEF WARDEN

F()ll ACCOUN I'S Sl.t(' t IO\ I St' ()Nt.Y

Ms./Mr has deposited her/his fees amounting

to Rs. vide Receipt No. dated

Dated Signature ofCashier

 e@ I falt]e REGIONAL INSTITUTE OF EDUCATION, AJMER
(National Council of Educational Rcscarch and Training) Affix
(NAAC rcctcditcd A+ Gradc Inslitutiorr of NCER'I) la tcsl
photo
qrfrrfirE
NC RT

MEDICAL CERTIFICATE

Name: D/o S/o Shri

Age: ............,............... Sex: Height Weight: .

Vision : Distance

Near

Remarks (if any):

Color vision

(Inability to distinguish between principal colours)

Congenital or other diseases

Hearing

(Whether defective, must be corrected)

Pregnancy (Female candidate): Yes /No

+ I hereby certify that I have examined Ms./Mr.

a candidate for admission to Four Year B.A.B.Ed./ Four Year B.Sc.B.Ed./ Two Year B.Ed./ Two

Year M.Ed. Programme/ Diploma Course of Guidance and Counselling (DCGC) in the Regional
Institute of Education OJCERT), Ajmer (Rajasthan) and could not discover that she/he has any
desease except

I do not consider that her/his will hamper her/his studies for the above mentioned
programme/course.

Date MEDICAL OFFICER

Place SEAL

* This certificate is to be given by a Medical Officer of a District Gor.t. Hospital or Superintendent

of Medical College/Hospital in the State.
 LINDERTAKING BY STLIDENT

I (name of student) D/o S/o

do hereby undertake that in case my phasewise attendance is lound short (as

per M.D.S.U., Ajmer norms) in R.l.E., Ajmer for the (Session/Semester) in

class my admission from this Institution or Hostel or both may

be cancelled.

Signature of the Student.

Name of the Student...............

Session 20......- 20......

LND BY PARENT S/GUARDIAN

I (name of parent) (Relation)

of (name of student) do hereby undertake that I am aware of

attendance rules (M.D.S.U., Ajmer) and cancellation of admission due to shortage in attendance.

In case the shortage of the attendance of my ward (name of

student), her/his admission may be cancelled from the Institute or Hostel or both.

Signature of the Parents/Guardian..............

Name of the Parents/Guardian

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 DECLARATION / UNDERTAKING

I, Ms./Mr. . D/o Wo S/o Shri

in the light of Supreme Court judgment hereby solemnly declare that:

I have never indulged in any incident of ragging nor I will indulge in such kind of act in future. IfI am
found indulged in such activities of ragging, my admission will be automatically stand cancelled.

I have gone through all the rules and regulations of the Institute and I agree to abide by the same. I will
adhere to all the rules pertaining to discipline of the hostel and the Institute. In previous classes I was
not involved in any act of indicipline. I shall not indulged in any indicipline activities leading to damage
of Hostel/lnstitute furniture, CCTV Camera's etc. I also declare that I shall submit the hostel admission
form in the stipulated time. I shall not take any part in the unauthorised occupancy in the hostel room. I
also declare that I am not working in any government/semi govemment/autonomous/private institution.

, I was never charged of any misbehaviour/crime and neither I have been released on bail in matter of
any criminal act and no criminal case in pending against me in any Court of law.

4 No complaint/FlR has been lodged against me by any authority of previous lnstitution in which I
studied.

5 I am wellaware ofthe University rules regarding 80% attendance in each subject, which is compulsary,
failling which I shall be debarred from taking the examination. IfI remain absent without intimation to
the Institute continuously for l5 days or more from the Institute for any reason, my name shall be struck
of automatically from the students roll.

6 I shall attend classes regularly in the lnstitute and my admission can be cancelled if I continuously
remain absent without the permission of Principal for a period of fifteen days or more. If, due to
shortage of attendance, I am detained from appearing in the University Examination the responsibility
would be of my own.

1 I hereby undertake that I shall participate in all the celebrations hosted by the Institute positively and
abide by all the rules and regulations of the Institute. In case of my unsatisfactory conduct in and or
outside the Institute, my admission may be cancelled and I may be expelled fiom the Hostel and or
Institute.

8 I declare that all the enteries in my admission form are true and correct to the best ofmy knowledge and
belief. In case anyhing is found wrong/inconect my admission will automatically stand cancelled.
9 In case any relevant information is found to be suppressed by me, my admission can be cancelled at any
time.

10. I shall abide the rules and regulations mentioned in ordinance of Maharshi Dayanand Saraswati
Univeristy, Ajmer.

Date

Signature of the student_

Name

Class

My latest address is:-

I agree to abide by the declaration/undertaking given by my ward.

Signature of the parents/Guardian

Name
I{elation rvith the student
Emergency contact number
 ANNEXUIRE-I

Ih'DERTAKING BY THE STUDENT

(full name of student with admission/r€gistration/enrclment numb€r)
s/o d/o l\'lr./Mrs./Ms. , having be€n admitted
ro (name of the in$itutio[] have received a copy
of the UGC Regulations on Curbing the Menace of Ragging in Higher Educational Institutionq 2009, (hercinaftei
called the "Regulations") carefully read and & fullyunderst@d the provisions contained in the said Regulati'ons

(2) I havg in particular, perused clause 3 ofthe Regulations atrd am aware as to what collslitul€s ragging.

(3) Ihavc aho, in partic,lar, penrsed clause 7 and clause 9,1 of the Reguhtixu and am fully
aware of lhe penal and
administrative action that is riabre to be taken against me ir case l am found guirty of or abetting ragging,
actively or passively, or being part of a conspiracy to pro note raggin&

(4) I hereby solemnly aver and urdertake that

(a) I wirl not indurge in any bchaviour or act that may be constituted as ragging under crause 3 of the
Regulations.

(b) I will not participate in or abet or propagate through any act of commission or omission that may bc
constituted as ragging under clause 3 of the Regulations
(5) I hcreby amrm that, iffound guirty ofragging, r am riabre for punishmcnt according to crause 9.1 ofthe
Regulations' without prejudice to any oth€r criminar action that may be taken against mi under any pcnar
law or any law for the time being in force

(6) I h€reby declare that I have not been expelled or debarred from admission in any institution in the country on
account of being found gu ty of, abetting or being part of a conspiracy to promote, ragging; and further aflirm
that' in case the declaration is found to be untruc, I am aware that my admissioD is liable to be cancelled.

D€chred thi!_ davof _ month of year

Signature ofdeponent
Name:

VERIFICATION

Verified that the contents ofthis underlrking are true to the btst ofmy knowl€dge and no part ofthe undertaking is false
and nothing has been concealed or misstated therein.

Verificd at (plflce) on this the day) of (month), (y€ar).

Signatu re ofdeponent
Name:
 {-ffrr{6-I

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 ANNEXUR.E-II

tiNDERT KING BY PARENT/G UARDIAN

I, Mr./Mrs/Ms, (full name of parent/guardian)

father/mothcr/guardian of, (full name ofstudent with admission / registration/enrolment number) having been
admitted to (name of the lnstitution) have received a copy of the UCC Regulations on Curbing the Menace
of Ragging in Higher Educational Institutions, 2009, (hereitrafter called the "Regulations"), carefully read and
fully understood the provisions contained in thc said Regulatiotrs."

(2) I have, in Particular, perused clause 3 ofthe R€gulations and am aware as to what constitut€s ragging.

(3) I have also, in particular, perused clause 7 alrd clause 9.1 of the Regulations and am fully aware of the
penaland
administrative action that is liable to be tak€n against my ward in case he/she is found guilty of or
abetting ragging, actively or passively, or being part ofa conspiracy to promote ragging.

(1) I hereby solemnly aver and undertake that

(a) My ward will not indulge in any b€haviour or act that may be constituted as ragging under clause 3 ofthe
Regu lations.
(b) My ward wil not participate in or abet or prcpagate through any act of commilsion or omislion that may
be constituted as ragging under clause 3 ofthc Regulations.

(5) I hereby allirm that, if found guilty of ragging, my ward is liable for punishment according to clause 9.1
of theRegulations, without prejudice to any other crimhal action that may be taken against my ward under
any penal law or any law for the time being in force,

(6) I h.reby declare that my ward has not been expelled or debarred from admission in any institution in
the countryon account of being found guilty of, abettitrg or being part of a conspiracy to promote,
ragging; and further aflirm that, ir cas€ the declaration is found to be untrue, the admission of my
ward is liable lo be cancelled.

Declarcd this dav of month of year.

Signature of deponellt
Name:
Address:
Telephonc/Mobile No.:

VERIFICATION

verilied that the contents of this urdertaking are true to the besa of my knowledgc and no part of the
undertaking is false and rothing has beetr cotrcealcd or misstated therein.

Verified at (place) on this the (day) of (month), (year).

Signature ofdeponent
Name:
 e-gtrr.ro-II

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 No.
REGIONAL INSTITUTE OF EDUCATION AJMER
(National Council ofEducational Research & Training)
(NAAC accredited with A+ Grade Institution of NCERT)
qi6€r"lA Affix
NCGRT Annlication for Hostel A dmission
latest
Session 2018 - 2019 photo

l. Name of Student ...Mob.No.

2. Aadhar No.
3. Mother's Name ....Mob.No
4. Father/Husband/Guardian's Name ....Mob.No
5. Permanent Home Address

6. Local Guardian and Address (ifany) :

with Phone/Mobile No.

7. Programme/Course Admitted to
8. Date of Admission
9. Fee Receipt No.: ....................and Date.....................
l0.Name and Address of Persons to be contacted in emergency :

(l) ....... MobileNo...

(2) ...... ......... ... .. MobiteNo.
I l.Declaration: (i) The above information is correct to the best ofmy knowledge and belief.
(ii) I have read and fully understood the rules and regulations ofthe hostel. I shall abide by them.
(iii) In case I fail in the University Main Examination, I shall immediately vacate the hostel.

Dlte: Signature of the Student

Remarks of the Head of the Department : Recommended,Not recommended for admission.

Date: Signature of HOD

OITDER

Ms./Mr
is hereby provisionally allotted Room No.................. in .... Hostel w.e.f.
Her/His admission is subject to her/his good conduct during the stay in the hostel

Warden Chief Warden

ACKIIOWLEDGEMENT

I have occupied Room No........ of.............................. Hostel. I have taken possession ofthe
following articles which are in good condition. The safe custody ofthese articles is my responsibitity. Ifl
am found involved in any activity leading to damage to the hostel property, I will bear the expenses ofthe
damage.

Table-1, Ceiling Fan-1,

Chair-1, Complete Tube Lighr- I

Cot-1,
Signature of the Hosteler
Place: Ajmer
Date:

This form should be submitted to the Hostel Clerk