(Form can be downloaded from college website, the DD should be in favour of ‘Principal, Engineering College, Bikaner’ payable at Bikaner)
Detail of D.D.:
DDno.….…………Dated…...… Bank Name……………………..
Form No. ………………….. Date of Receipt ……………………
Gen./OBC/SC/ST/SBC/ …Tot% (incl. bonus) ….. Ad. No. /Merit….. Class/Section…………..
Govt.Engineering CollegeBikaner
[An Autonomous Institution of Government of Rajasthan]
/ M.Sc.(Physics)Department of Physics
To
Principal
Govt. Engineering College, Bikaner
Sir,
I ……………………………….…………S/o,D/o …………...………….……….……… am
submitting an application for seeking admission in the M.Sc. (Physics)Courseconductedby
Physics department of your college.Following details are beingsuppliedto you for your kind
persual.
To be filled in capital letters only.STUDENT PROFILE
1. NAME
2. FATHER’S NAME{do not write Mr./Sh. Etc before name}3. MOTHER’S NAME{do not write Mrs./Smt. Etc before name}
4. NAME OF GUARDIAN (In absence of Father and Mother) 5. RELATION WITH APPLICANT
6. FATHER’S OCCUPATION 7. Whether he/she is tax payee (Yes/No)
8. DATE OF BIRTH 9. SEX 10. CATEGORY{ Mark sign at appropriate box not }
DD / MM / YY / Male / FemaleGEN / SC / ST / OBC / PH / OTHERS
11. ADDRESS(Current) { Please do not repeat parents name }
City/Village / DistrictPin
12. ADDRESS (Permanent){ Please do not repeat parents name }
City/Village / DistrictPin
13. CONTACT NUMBERS{With STD code} MOBILE NO.(Self) Alternate contact number{ Father / Mother }
14. AADHAR CARD NO. (if any) 15. Email Address(if any)
16. Any other reservation ………………….. (Please provide relevant certificate)
17. RESULT OF QUALIFYING EXAM. .…………… (Pass/Supplementary/Result awaited/Others)
Date:Signature of Applicant
18. EDUCATIONAL QUALIFICATION
STANDARD / YEAR / BOARD/UNIV. / REGULAR/
PRIVATE / Optional
Subjects / Marks in Physics / Total Marks / Obtained Marks / %
Total / Obtained
10th
12th
B.Sc. Part-I
B.Sc. Part-II
B.Sc. Part-III
Note: If there is semester scheme then provide detail of all semesters.
19. Information of earlier enrollment of the candidate (If applicable)
Student Registration no……………………Course ………………. University enrollment no. …………….
20. List of certificates/ documents to be submitted by candidate (Self attested/attested by gazetted officer)
S.NO. / Document / Attestation (defined Self attested or by G.Officer or Original Copy) / Enclosure No.1. / 10thMark sheet / Self attested
2. / 12thMark sheet / Self attested
3. / Domicile Certificate / Original
4. / Character Certificate / Original
5. / B.Sc. Part-I Mark sheet / Self attested
6. / B.Sc. Part-II Mark sheet / Self attested
7. / B.Sc. Part-III Mark sheet / Self attested
8. / All 6 semesters of B.Sc. (PCM) (semester scheme) / Self attested
9. / SC/ST/OBC/SBC/PH Certificate / Self attested
10. / Kashmiri Migrant / (for benefit in this category)
Self attested
11. / Certificate in relevance to bonus marks [NSS, NCC, Scout/Guide, Rover/Ranger, Sports, Curricular activities, Ex-Serviceman, any other certificate] / G. Officer
(for benefit of bonus marks)
Total no. of enclosures ……………………………………….. (in words………………………………………..)
21. PLEASE FILL THE FOLLOWING COLUMN
S.NO. / Particulars / Yes / No.1. / Do you require hostel of the college
2. / Have you been punished before it
3. / Have you been restricted for the examination
4. / Have you been declared physical handicapped / blind / physically disable etc.
5. / Do you require college transportation
Please enclose the concerned document.
Date:Signature of Applicant
22. DECLARATION BY APPLICANT:
I …………………………. S/o / D/o …………………………………. declare that -
(i)I have read all the rules and regulation of the college and they will be followed by me. Also, I will not cause any damage to college property.
(ii)I have not been involved in ragging and also will not be involved in such kind of criminal activities. My candidateship may be cancelled in case of any involvement.
(iii)Any kind of criminal offence has not been registered against me in the court.
(iv)I will secure the minimum attendance prescribed by the Maharaja Ganga Singh University, Bikaner for M.Sc. (Physics).
(v)During the session I will not be employed in any kind of Govt./Private or autonomous body.
(vi)All the rules and regulation prescribed by the Maharaja Ganga Singh University, Bikaner for M.Sc. (Physics) course is expected to be followed by me.
(vii)I will not study in any other college parallel to this course.
(viii)The documents/Certificates provided by me with this application form are authentic and in case of any misinformation my candidateship may be cancelled.
Date …./…./……..
Place ………………………… (Signature of Candidate)
23. Whether you want to participate in any of the following activities in the college.
(a) NCC[] (b)NSS[ ] (c)Sports/Others[]
Receipt of Application Form
- Name of Course /Class ………………………………………………………………………
- Name of Candidate ……………………………. Father’s Name ………………
- Academic Session ………… S.No. ………………… Date ……………….
- Received by ……….
Recommendation for Admission
- Applicant’s Name …………………………… 2. Father’s Name…………………………………..
- Applied Course/Class ………………………………………………………………………………
FOR OFFICE USE ONLY
Serial No……………………………. Date of Submission ……………………. Received by …………………………
To be filled by admission committeeMr./Miss…………………………………………has submitted an application for seeking admission in M.Sc.(Physics) Course-2017-18.
S.No. / Details of Marks/Percentage of / Total Marks / Obtained Marks / % age / In Physics
Total Marks / Marks obtained
1. / Secondary Exam.
2. / Sr. Secondary Exam.
3. / Graduation for admission in M.Sc. Physics (Previous)
4. / Marks obtained in B.Sc. Part-I
5. / Marks obtained in B.Sc. Part-II
6. / Marks obtained in B.Sc. Part-III
7. / All 6 semesters (Semester scheme)
8. / Marks/percentage to be added according to admission policy (+)
9. / Marks/percentage to be deducted acc. to admission policy (-)
10. / Bonus
Total
To be filled by admission committee & Principal
1. / Applicant is selected for admission
Merit No. ………………………………………….. Category ……………………………………….…… / Admission is granted / Provisional admission is provided
2. / Applicant is not selected due to
………………….……………………………………
Member
Admission Committee / Coordinator
admission committee / Principal
Govt. Engineering College, Bikaner
For Account Section
Date of Receipt …………………….. / Challan No. ………………………………………..D.D. Detail / DD No. :
Bank :
Cash (please submit the bank receipt) / Received by
Auth. Signature
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Dave