Panjab University, Chandigarh

Online Examination Form for Under Graduate Examination Dec 2023

No need to submit this form to Panjab University .

Candidate Type Private Candidate (Reappear Candidate)

Application No. 1723400512
Regd./PUPIN NO. 19720000404
Category Scheduled Caste
Centre of Examination Sri Muktsar Sahib

Name of Candidate ANSHUL JUSTIN

Father's Name T R JUSTIN
Mother's Name ELIZABETH
Date of Birth
PaymentType: Bank
06-05-2000
Txn No. CPADCROQK3
Aadhar NO. ANSHUL
751982915836 Name
JUSTIN
Amount(Rs) 2980
Gender Male
25-09-2023
Deposit Date
00:00:00
Nationality Indian
Branch Code 742
Working in Government/Public Sector No
Mobile 7717479196
Email ID [email protected]
Correspondence Address NEAR H.K.L. HOSPITAL, FRIDKOT ROAD, GHS,152022
Permanent Address NEAR H.K.L. HOSPITAL, FRIDKOT ROAD, GHS,152022
Course Information:
Course Bachelor of Computer Application
Semester /Year 5
Current Subject(s) 1. Discrete Mathematics in Computer Science [BCA-503]
Previous Information:
Course Bachelor of Computer Application
Semester/Year 6
Result Pass but RLL
Roll No. 20053782
Passing Year 2023
University Panjab University, Chandigarh
Subject(s) BCA601,BCA602,BCA603,BCA604,BCA605
Other Details:
Applied for Re-Evaluation No
Blind/Permanently disabled from writing No
Is UMC No
Is Environment Exam Passed No
Applied For Environment Exam No
I have filled the form after careful study of the University syllabi, structural outlines of the
course,rules and regulations pertaining to the year and session of the examination, under
reference. The statements made by me in the form are correct. I accept full liability for any
action against me under the rules/regulations of the University for any mis-statement or
concealment of facts made by me.
Place:
Date: 25-09-2023 Full Signature of Candidate
 Panjab University, Chandigarh
Certificates
(For College/ Department of Evening Studies/University school of Open Learning Candidates)(Strike out which is
not applicable).
Certified That :
1. The candidate has remained on the rolls of this College/Department for the full academic year preceding the examination.
2. The candidate has passed, at least one academic year previously (except in compartment
cases, appearing simultaneously), the lower examination with the required subjects and % age of
marks on the basis of which he/she is eligible to appear in the exam.
3. The candidate has attended not less than 75% of the full course of lectures delivered to his/her
class in each of the paper being offered for examination.
4. The candidate has attended not less than 75% of periods assigned to practical work in each
science subject or Psychology, Home Science or in the case of Geography, Map work and
Practical and 80% each in the subjects of Physical Education and Defence and Strategic Studies.
5. The candidate has obtained at least 25% marks in the aggregate of all the combined results of
(a) the house examination held in November/December and (b) the internal assessment based on
three monthly class tests held in August, September and October respectively.
6. This college has duly been granted affiliation by the Panjab University which is valid upto date in the Course(s) being
offered by the candidate in his/her examination form and the number of candidates admitted and being sent for examination
is within the strength sanctioned by the University for the Course/Session.
7. The candidate bears a good moral character, that he/she has filled in and signed this examination form in my presence
and has further satisfied by production of authentic documents, that the statements made by him/her in the form are correct.

Place:_________________
(Full Signatures of the Principal/Chairperson Deptt. of Evening
Studies/University School of Open Learning with official stamp)

Dated:_________________

Full Name of the Principal of the College/Chairperson

(Name of the College/Department with official Stamp)
__________________

Certificate for Late College Students (Colleges/University School of Open Learning/Evening Studies)
I certify that the applicant : -
(a) has previously appeared in the examination under Roll No.________________________ in Session________________ Year
_____________.
(b) has completed the prescribed course of lectures/practicals etc in the college or has been on the rolls of the Department
of Evening Studies/University School of Open Learning from July 20__ to April, 20__ in the subject/s offered by him/her and
has paid continuation fee of Rs. 40/- vide Receipt No.____________ Dated_______________.

(c) bears a good moral character.

(d) has signed the examination form in my presence and satisfied me by production of authentic documents and the
statements made by him/her are correct.

Full Signature of the Principal of the College/Chairperson

Date:_________________
U.S.O.L./D.E.S. (Last Attended) (With Official Stamp)
 Certificate for Private Candidates (other than late college students) (Items not applicable may be struck off)
I Certify that :
(i) I know the applicant personally. He/she bears a good moral character. His/her attested photograph is affixed. He/she has
signed this examination form in my presence and has satisfied me by production of authentic documents that the
statements made by him/her in the form are correct.
(ii) The applicant has been in continuous service since ______________________________ and will
continue to be as such till the commencement of the examination. He/She has completed at least
3 year service on 30th November preceding the year of examination
(a) Name of Institution/Organisation/Deptt.___________________________________(b) Date of Joining
________________ (c) Rank/Designation ________________________
(iii) He/She has not been a regular student of an affiliated college during the academic year
preceding the examination.
(iv) There is no Evening College/Evening Classes in any college at the place where the applicant is
employed OR he was not granted departmental permission to join the Evening College/Evening
Classes by the employer due to the nature of his duties (Attach certificate) OR that the applicant
was not granted admission in the Evening College/Evening Classes by the Principal. In case there
are more than one Evening College/Classes, this certificate may be obtained from all of them.(This
certificate is not needed by women candidates).
(v) For Defence Personnel Only: (a) he/she is a bonafied (permanent) resident of
_______________District in the
State of Punjab/Haryana/Himachal Pradesh/Chandigarh (U.T.) _________________________
(b) He has been working in the ____________________ State since (Month)______________
(Year)______________ and will continue till the commencement of examination.

Note : Teacher of Govt. Primary/Middle/High School should get their forms attested by the Distt. Education Officer/Circle Education
Officer.

(Signatures & Stamp of the Head of

Institution/Organisation/Deptt. where candidate is employed or
any other attesting authority)
Name of the Attesting Authority(in Capitals)
Designation:_________________
Dated: _________________

CHECK LIST OF DOCUMENTS/INFORMATION (To be supplied by the Private Candidates Only)

If you did not attach the following documents,you may be declared Not Eligible.
1. Have you passed the qualifying examination from this University? Yes/No. If yes, there is no need to attach the original
Detailed Marks Card.
2. (a) Have you passed the qualifying examination from the Board/University/Council other than Panjab University? Yes/No
(b) If yes,attach the Original Detailed Marks and Migration Certificates from the Board/University/Council.
3. Have you got your examination form attested by a competent authority as prescribed by the Panjab University?Yes/No
4. Have you filled in all the columns of the examination form properly and that no column has been left blank?Yes/No
5. Have you attached three copies of your latest passport size photograph from one and the same negative?Yes/No
6. Have you attached the SC/ST/BC certificate issued by the competent authority (if applicable)?Yes/No
7. Have you paid late fee, additional fee, special fee etc. (if any)Yes/No

Date _________________ (Full Signature of Candidate)

(For Office Use only)

Eligible _________________ Not Eligible_________________

Eligible Subject to_________________ Reasons_________________

Dealing Official A.S.O. O.S.E. Dealing Official A.S.O. O.S.E. A.R.E