Enrollment No _________________________
CHHATRAPATI SHIVAJI MAHARAJ UNIVERSITY, PANVEL, NAVI MUMBAI
FORM OF APPLICATION FOR ADMISSION TO AN EXAMINATION,20..............................
(As Regular Student/Back/ATKT Students).................................................................
S.No...........................................................................
Enrolls ment No............................................................ For Office Use Only
Self Sign Passport
(To, Be filled by the Candidate) Size Photograph
Receipt No.:........................
Roll No....................................................(Leave Blank) duly attested by the
Faculty Name:............................................................ Date:................................... dean of the faculty
Name of Program.......................................................
Enrol. No:...........................
Semester....................................................................
To,
THE CONTROLLER OF EXAMINATIONS,
CHHATRAPATI SHIVAJI MAHARAJ UNIVERSITY,PANVEL,
NAVI MUMBAI
Sir,
Given the following details I request permission for admission to the ensuing .................................................
Examination of the University. (Write Name of Examination)
1. Name in full in BLOCK LETTERS (Woman candidate must write Miss or Mrs. before her name)
_________________________________________________________________________________________________________
2.Father Name: ____________________________________________________________________________________________
3.Mother Name:___________________________________________________________________________________________
4. Gender: Male Female TG
5.Date of Birth(DD/MM/YYYY):________________________________________________________________________________
6.Nationality:__________________________________Passport No.:_________________________________________________
7.Permanent Postal Address of the candidate (in full) :_____________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
8.Phone No:_________________________________________Mobile No:_____________________________________________
9.Catagory: GEN OBC SC ST SBC Minority Physically Handicapped Others
(Enclose Photocopy).
10.Religon: Hindu Muslim Sikh Catholic Jain Buddhist Parsi Others
9.(i) Name of the Last qualifying/Previous examination passed_______________________________________________________
(ii)Details of passing the above examination and Roll Numbers under which passed:
(a)Year_____________________________________________ (b) Roll No__________________________________________
(c) Month___________________________________________(d)Semester_________________________________________
10(a).Whether Appearing the Examination for the first time, Year Month Seat. No No. of Attempt
If not, year(s) and month(s) in which he/she previously ................ ................. ................. .....................
appeared and failed to be given ................ ................. ................. .....................
................ ................. ................. .....................
(b) Subject(s) in which appearing at the ensuing examination. (1).................................................(2).................................................
(3).................................................(4).................................................
(5)..................................................(6)................................................
(7)...................................................(8)...............................................
(9)...................................................(10)..............................................
11. Whether simultaneously appearing at any other examination ............................................................................................................
of the University? If so, Give the Name of exam in which appearing.
Declaration of Student: I declare that, I will follow all the directives issued by the university regarding changes in mode of
conduct of examination (Online/Offline/Blended) in view of directives of Govt. of Maharashtra/ Central Govt./ U.G.C./ any other
regulatory bodies such as B.C.I., P.C.I. etc.
............................................................
Full Signature of Candidate with Name
___________________________________________________________________________________________________________
Certificate
Certified that................................................................ Enrollment Number.....................................................is eligible to appear
at.............................................................Examination in Theory and Practical subjects.
1..............................................2..................................................3............................................4.................................5.....................................
.6....................................................7...........................................8..............................................9................................10..................................
.
Concerned Dean
CHHATRAPATI SHIVAJI MAHARAJ UNIVERSITY
PANVEL, NAVI MUMBAI
(Centre Copy)
.........................................Semester..................Examination,.......................,20......
(Write the name of Program) (Month) (Year)
(As Regular Student/Back/ATKT Student).............................
Note: All Entries Should be filled in by the candidate except Seat. No. and Examination Centre Name
Attempt No.(Only For Back(KT) Students)............................................................. Examination Centre Name...........................
Enrollment No....................................................................................................... ......................................................................
1. Name of Candidate:......................................................................................... ......................................................................
2.Fathers Name:.................................................................................................. Seat Number.................................................
3. Name of Subjects Name in which appearing.
1.................................................................2........................................................... Self Sign Passport Size
Photograph duly attested by
3..................................................................4......................................................... the dean of the faculty
5...................................................................6..........................................................
7...................................................................8..........................................................
9..................................................................10.........................................................
Signature Attested
............................................................. ................................................................ ...................................................
(Signature of Candidate in Full) (Signature of Candidate in Full) Supdt. of the Exam Centre
(To be Taken in Exam Hall)
_____________________________________________________________________________________________________________
CHHATRAPATI SHIVAJI MAHARAJ UNIVERSITY
PANVEL, NAVI MUMBAI
(Student Copy)
.........................................Semester..................Examination,.......................,20......
(Write the name of Program) (Month) (Year)
(As Regular Student/Back/ATKT Student).............................
Note: All Entries Should be filled in by the candidate except Seat. No. and Examination Centre Name
ADMIT CARD
Attempt No.(Only For Back(KT) Students)............................................................. Examination Centre Name...........................
Enrollment No....................................................................................................... .....................................................................
Please Admit......................................................................................... .....................................................................
Son/Daughter of:.................................................................................. Seat Number................................................
to the ......................................... Semester.................. Self Sign Passport Size
(Write the name of Program)
Photograph duly attested by
Examination,.......................,20...... (As Regular Student/Back/ATKT Student).............................
(Month) (Year) the dean of the faculty
in the Following paper
1.................................................................2...........................................................
3..................................................................4.........................................................
5...................................................................6..........................................................
7...................................................................8..........................................................
9..................................................................10......................................................... Controller of Examinations
(CSMU, Panvel)
Date:...........................................................
_____________________________________________________________________________________________________________
