Patliputra University, Patna

Under-Graduate (UG) Admission Registration Form

SESSION 2019-2020
URN # 19G0012424 Reg Date: 16 May 2019 11:16 AM

1. Candidate Name:
2. Father’s Name :
3. Mother’s Name :
4. Date of Birth : 5. Gender : PHOTO

6. Category: 7. Sub Category:

8. Other Category: 9. AADHAR:
10. Domicile: 11. Dom. Cert.:
SIGNATURE
12. Religion: 13. Minority:
14. Nationality:

15. Address for Correspondence: 16. Permanent Address:

KASTURI BIGHA, ISLAMPUR KASTURI BIGHA, ISLAMPUR
NALANDA NALANDA
BIHAR BIHAR
PIN CODE: 801303 PIN CODE: 801303

17. Mobile: 18. Email:

19. Payment Details:
20. Qualifications
Examination Board/University Year Roll No Max. Mrk. Obt. Mrk.

Subject/Stream: Science
Other Qualifications
21. College/Course Chosen (by order of preference)
(1) [432] Snatak College, Islampur, Nalanda B. Sc. Mathematics (Hons)
(2) [432] Snatak College, Islampur, Nalanda B. Sc. Physics (Hons)
Declaration
I declare that I have been convicted for any criminal act and that there is no case pending against
Me in the court of law. I also declare that I have never been caught using unfair means, the punitive
duration is over and charges have been cleared. I have read carefully and have also understood all
rules as mentioned in the university. Rules and admission brochure. Furthermore I declare the if my
application is found to contain incorrect/false information regarding my Name, Birth Date, Gender,
Religion, Domicile ,Weight age, caste, horizontal reservation, marks, ,obtained of any other field, my
application is liable to get cancelled, and I will have to objection in getting disqualified for admission
to the conceded course/college

_________________________ ________________________
Signature of Parent/Guardian Signature of Candidate
Date: _______________________ Date: _______________________

Printed: Thursday, May 16, 2019 11:23 AM Page: 1/2S