MADHAV UNIVERSITY, Abu Road (Sirohi) APPLICATION FORM FOR ENROLMENT/ELIGIBLITY/ADMISSION Session : 20........ - 20... University Receipt NO. ....nmnnnmnnnnnnmnnnnnnmnssns DAEM nsnnnsnimnnnsninnnnnnnne Salebiciza Bank Draft No Dated ssp sie Name ofthe issuing Bank City eae duly attesed Course/Class Details : Name ofthe Course Class, in which the candidate wants to seek admission Branch / Specialization / Trade : . In case of B.Sc., Please specity group CBZ. / PCM. (Please Tick) {In case of Engineering, please specify branch : Mechanical / Electrical / Electronics / Civil / Computer Science / IT In case of B.Ed, please specify two teaching subjects as per subjects in your graduation ie 2 _ = (You have to choose one of the subject combinations out the prescribed combinations given in the prospectus - B. Ed. Section) Enrolment No. (New Admission): Incase of Ex-Students, University Enrolment No.: Personal Details : ‘Aadhar Card No. Name (in block letters) Mr/Mrs./Miss :~ = i : : Gender (Please Tick) : Male / Female (As Per Matric Certificate) Father's Name (in block letters) Shi. See (As Per Matric Certificate) Mother's Name (in block letters) Smt :- (As Per Matric Certificate) Date of Birth. (As Per Matric Certificate) Permanent Address (in block Letters) = Correspondence/Local Address (in block letters) Bonafide Resident of Rajasthan (Please Tick) : Yes( )/No( Category + General / OBC / SBC / SC / ST / PH / Ex. SM (Mark the appropriate) Nationality 2 .-Annual income of the family: .cunsonnsnnnonnnnnsnnnn ‘Ate you employed ? S¥es()/Mo (yes attach departmental pemision) ‘Ate you applying forhostel? = Yes(—-)/No (__) if yes, please fill up the separate Hostel Form) ‘Ate you applying for Bus Facility 2: Yes( )/No (__) (ifyes, please fill up the separate Transport Facility Form) Have you ever been expelled/rusticated/punished on account of misconduct by any institution? : Yes / No (if yes, Please give details: Institution Year Duration ) MObIIENO nnn a sosnmnannanelternate MObIIE NO. +. Email 1D (in running letters) Email ID (in block letter) -Educational Qualificatior rm ey For Candidates already studying / registered in this university Class, in which the candidate wants to seek admission Details ofthe previously passed exams of this university Class / Exam passed : Registration No. - Result = Passed / Reappear / Failed (Please enclose xerox copies of detailed marks cads of previously passed exams ofthis university) Have you cleared all dues ofthe previous year : Yes / No (\f Yes, please attach xerox of No-Dues Certificate) No, outstanding amount standing against you (Please specify details) (For Office Use Only) Date. Note : Pease tick agains the documents / attested photocopies, attached with admission from. (2) 1 DMcs / Certificates from matric to last qualifying examination passed -X(_), XII(_ ), Graduation (_ ) (b) 1 Migration Cerificate in original (©) — Relevant certificate in support of reserved category. (OBC / SBC / SC / ST/PH /Ex. SM) (@) Six recent Passport size colored photographs. (e) Certificate in support of bonafde resident of Rajasthan (i aplicable)/AADHAR CARD. (f) 9 Affidavit () No Objection Certificate from employer (in case of employed applicant) ees Eligibility & Documents Checked by Verified by Declaration Declaration by the Applicant duly counter - signed by Father / Guardian : 1 Slo / D/o hereby declare that entries made by ‘me in this admission from and the documents submitted by me along with i, ar true tothe best of my knowledge, in all respects and in any cease, if any information is found to be false, this shall entail automatic cancellation of my admission, besides rendering me liable to such action, as the University may deem proper. | note that my admission to the University and continuation on its roll are subject to the provisions / rules of the University, issued from time to time. | shall abide by the rules of discipline and proper conduct. | am fully aware of the aw regarding ragging as well as the punishment and thatf, found guilty on this aecount | amiable to be punished appropriately | shall undertake that | shal not indulge in any act of ragging, In any circumstance, | will not claim for refund of fees deposited by me the university Date : Place Signature of the Father / Guardian ‘Signature of the ApplicantMADHAV UNIVERSITY, Abu Road (Sirohi) 1. Aadhaar Card No = (Attach Xerox copy of your aadhaar card) 2. Name: Eee : 3. Father's Name: ~ 4, Permanent Address e B. MObil€ NO? ev ewne Altemative Mobile No:.. 6. E-mail a = 7. The city, from where you want to board the University bus Name ofthe city e 8, Name of the designated chowk / particular landmarked place, from where, you want to board the bus TRANSPORT DUES ( ROUTES ) SIROHI TO UNIVERSITY SIROHI (1850) \VEERWARA (1600) SANWARA (1600) JHADOLI (1400) SIROHI ROAD (1400) KOURA (1200) BANAS (1100) CCHAWARL (1200) KODARLA (1000) DHANARI (1000) CHANDRAWATI TO UNIVERSITY CHANDRAWATI (1300) RIICO GARDEN (1100) STPAULS (900) ORE (750) Check Post (1100) GANDHINAGAR (900) Mahaveer Cinema (900) ABU ROAD TO UNIVERSITY ‘ABU ROAD TO UNIVERSITY (1000) REODAR TO UNIVERSITY REODAR BUS STAND (1500) MUNGTHALA (1000) [MANPUR (900) TALHETI (900) KAROTI (1500) NEW TOWN (1000) AKRABHATTA (900) AMITHALA (900) \VASBHATANA (1500) CHAMUNDARY TO UNIVERSITY CCHAMUNDARY (1900) NANA (1800) AMLIA (1600) PINDWARA (1300) ‘SWAROOPGANA (800) ROHIDA (800) VATERA (800) BHIMANA (700) MOUNT ABU TO UNIVERSITY MOUNT ABU TO UNIVERSITY (2300) ‘The Payment for 10 Months is mandatory forall the students, who want to avail the University transport facility. This amount of is tobe paid in two equal installments 1* installment to be paid at the time of admission, 2 Installment to be paid in the month of January next year. Declaration Regarding Transport Dues \ Slo. have read the payment details of availing the bus transport facility. hereby, shall abide by the above payment schedule & also other rules & regulations, as framed by the University from time to time. Incase, I fal to remit ten months transport dues, | may not the Semester/Annual exam. ued 'No dues slp’ and | may be debarred from appearing Signature of the Guardian/Father Signature of the Candidate