INSTITUTE NAME
COURSE NAME
STUDENT NAME
FATHER NAME
MOTHER NAME
FATHER OCCUPATION
DATE OF BIRTH
Category
ADDRESS(LOCAL)


ADDRESS(Permanent)


MOBILE NUMBER (10 digit number)
QUALIFICATION






Sl.No. Examination Board Percentage Year of Passing
1
2
3
4
(10 char max) (upto 2 decimal)
Documents Submitted


High School Mark sheet Higher Secondary Mark sheet Graduation Mark sheet Post Graduation Mark sheet Diploma Mark sheet Character Certificate Transfer Certificate Migration/ Provisional Certificate Domicile Certificate Income Certificate Other Certificate
Others
Self/ on behalf of my ward hereby declare that:
1. The information given by me in the application form and all enclosures are true to the best of my
knowledge. However, should it, be found that any information/ enclosures therein are
untrue/ wrong I am/ my ward liable to be disqualified for admission.
2. If I am/ my ward selected for admission I am/my promise to abide by the rules & regulations of
the Institute/ University and maintain the discipline in the institute and the hostel.
3. Initially the admission is provisional and is subject to confirmation from the counseling authority
concerned University and State Government.
4. It is compulsory for me/ my ward to appear for online counseling at any place directed by the
counseling authority with in the specified date and time failing which I/ my ward’s registration
will be automatically cancelled without any refund of fee.
5. I understand that if I get my admission/ registration cancelled the fee deposited by me is nonrefundable.
6. Cancellation of admission/ registration is not possible without paying the full fees for the entire
course.
7. I undertake to abide by the “Student Leaving Midstream” clause of the prospectus and agree to
pay fees for the whole course if I leave course in midstream.
8. Any dispute is subject to Sehore Jurisdiction.