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DIETCET-2013
Marks Secured
Rank
OUT OF
% %
DIVISION
OUT OF
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If answer is NO Furnish details of places of Your stay during the last 10 years S.No. Place of Stay From Period To Total Stay
15. Details of Education : (From 1st Standard Onwards) Name of the School / College Place From Classes To Academic Years
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Category 18. Have you participated in any Games and Sports at International / National / State / University / College Level? If so give details, indicate Position Secured and enclose Supporting Certificates.
20. Address: Present / Local ___________________ ___________________ ___________________ Contact No. Land line : Permanent ___________________ ___________________ ___________________ ___________________ Address for Correspondence with Parents / Guardian ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ ______________________________
Mobile / Cell Phone (Father): ___________________ Mobile / Cell Phone (Mother) : __________________ Mobile / Cell Phone (Student) : __________________ E-mail ID :__________________
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(For Office Use) Application No. : Fees particulars : Amount paid Rs.: DD No. / Cash Receipt No. Date : Date : Entered in Admin. Register Date : A.O. / Clerk Admission Category : COUNCELLING / MNGMT QUOTA Admission Slip Sl.No. Date :
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UNDERTAKING TO BE FILLED IN AND SIGNED BY ALL STUDENTS (NEW ADMITTED AND CONTINUING)
I, _______________________________________________________ (name of the student) studying _____________________________________ (Year, Degree / Course, section), at _________________________________________________ (Name of the College), S/o/D/o_________________________________________________________ Residing at ___________________________________________________________, (Permanent Home Address with Phone Number), undertake that I am aware of the system of punishment in case of ragging other student. In case I found involved in any manner in any form of ragging case I am liable for any punishment, including: 1. Cancellation of admission. 2. Suspension from attending classes. 3. Withholding / withdrawing scholarship/fellowship and other benefits. 4. Debarring from appearing for any test/examination or other evaluation process. 5. Withholding results. 6. Debarring from representing the institution in any national or international meet, tournament, youth festival etc., 7. Suspension, expulsion from the hostel. 8. Rustication from the institution for periods varying from 1 to 2 academic years. 9. Expulsion from the Institution and consequent debarring from admission to any other Institution. 10. Fine upto Rs. 10,000/11. Rigorous imprisonment up to three years (by Court of Law) etc.,
Date: ______________
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