1

ADMISSION FORM


APPLICATION NO. (FOR OFFICE USE ONLY)
2 0 1 4 0 1 __ __ __ __

UNIVERSITY




STREAM


COURSE



COURSE CODE


SESSION


Name of Candidate


Gender


Date of Birth
T H D A Y O F

Marital Status


Employment Status


Name of the Organization, if Working



Father Name



Maiden Name








Paste
Passport Size
photograph.
Do not staple.
2

Address





Contact Number


E-mail Address


Education Details
Examination Level Board /University Marks/Grade Year of
Passing
Medium
X Class
XII Class
Graduation

Fee Structure
Due Dates Mode of Payment Amount Balance







Check List
Application form completely filled and signed
4 Passport size photographs
Photo Identity
Photocopy of Graduation Certificate
Photocopy of Standard XII/X mark sheet and certificates
Name Change Document

Certificate of Understanding
I declare that the information provided by me in the application form is true and correct to the
best of my knowledge. I am fully aware that in case any information provided is found false or
erroneous; it will result in cancellation of my registration/admission. I am aware of all the rules
especially related to
o Provisional Admission
o Payment of program fee, exam fee and other fee
o Program fee installment option and mode of payment
o Cancellation of admission
o Rules for refund of program fee
o Rules related to forfeiture of
o Jurisdiction
I also agree to abide by all the rules and policies of the institute.
I understand that CGPSR is working as an education consultant and not an admission center for
any university.
I have authorized CGPSR to apply in ___________________________ university on my behalf
for which they are charging their consultancy fees. And this will not amounts to sale of
prospectus / admission form to me. In addition, I have no objection on the amount so charges
as consultancy fee.


Place: ___________________ __________________________
(Signature of Candidate)
Date: ___________________