MALWA COLLEGE BONDLI-SAMRALA

ADMISSION FORM 2016-17

TO BE FILLED BY THE APPLICANT IN HIS/HER OWN HANDWRITING

  1. Name (Capital Letters)……………………………………………..Class………………………….
  2. Medium of instruction:………………………………………
  3. A)(1) Father’s Name……………………………………………………………..(2) Occupation……………………

B)(1) Mother’s Name………………………………………………………….....(2) Occupation……………………

C)(1) Grand father’s Name………………………………………………………(2) Occupation……………………

4. a) Category: SC/ST/OBC/General…………………b) Annual Income from all sources…………………….

c)Aadhar Card No…………………………….d) Name of Bank & Account. No………………………………………

5. DOB as per Matriculation Certificate a) In Words……………......

b) In figures. Day………Month…………Year………..

6. Permanent Address:-………………………………………………………………………………. Mail ID………….

…………………………………Father’s Phone No………………………Father’s Mail ID…………………………...

7. University/Board Registration No………………………………………………………………….

8. Details of Qualifications:-

Examination / Year & Month Of Passing / Roll No. / Marks Obt./ Total Marks / %age of Marks / Board/ University / Subjects
Matriculation
10+2
BA/B.Sc/B.Com/BCA Sem-1
BA/B.Sc/B.Com/BCA Sem-2
BA/B.Sc/B.Com/BCA Sem-3
BA/B.Sc/B.Com/BCA Sem-4
BA/B.Sc/B.Com/BCA-III
M.A./M.Sc. Sem-1
M.A./M.Sc. Sem-1
Any Other

NOTE: ATTACH SELF ATTESTED COPIES OF ALL THE CERTIFICATES AND AN AFFIDAVIT IN DUPLICATE IN CASE OF GAP YEAR ON PRESCRIBED FORMAT AVAILABLE IN THE OFFICE.

  1. Did you ever join any other college before? Yes/No. If Yes, give the following information:- a)Name of the College………………………………b) Class joined………………

c) Reason of Leaving……………………..(Attach Character Certificate)

10. Furnish the particulars of the gap period, if any……………………………………………

11. If you have any real brother/Sister studying in the College, provide the details

a) Name……………………………..b)Class…………………………..c)Roll No………………….

12. Subjects Offered: (a) Compulsory Subjects (Please tick) 1. ENGLISH 2. PUNJABI 3 3.HCP

(b)Elective Subjects: 1……………………………………….. 2……………………..……………3………………..………

4…………………………………………. 5………….………………………..6………………………

(C) Add On Course………………………….

13. For old college students only a) Class………………………..…b) Old college Roll No……………… Session……………….

14. Mode of Conveyance (Bus/Scooter/Motor Cycle)………………………………….

15. Distinction won in Games/Academics/Co-curricular activities, if any…………..

DECLARATION

  1. I declare that I am applying for admission in this college with the express approval of my father/guardian. I have read the college prospectus thoroughly and I accept as binding on me, all the rules and regulations, mentioned in the college prospectus and those framed by the college/University/Punjab Government from time to time.
  2. My name may be struck off from the college if I am ever found indulging in indiscipline and/or other activities considered undesirable by the Principal.
  3. I declare that I have not been disqualified by any University/Board in any examination.
  4. I understand that my admission is provisional, subject to the approval of the University. In case it is not approved by the University at any stage, I shall have no claim against the college or the University.
  5. I shall not claim any concession if I get reappear/compartment in the lower examination.
  6. I shall not indulge in ragging.
  7. I hereby declare that the particulars given above by me are correct and true to the best of my knowledge and belief.
  8. I will not claim the refund of fee once deposited.

Full Signatures of the applicant

I, father/guardian of the student hereby solemnly state that the particulars given above are correct. In the event of my son/daughter/ward being admitted to the college, I agree to be jointly and individually responsible for the full payment of his/her dues. I stand surety for the good conduct of my son/daughter/ward at the college.

Signatures of Father/Guardian

(For SC/ST/OBC Candidates Only)

  1. Old/New Student.Remarks:-……………………………….
  2. Eligible/Not Eligible for S.C/S.T/OBC. ……………………………………………………

Concession.…………………………………………………………..

Signatures of Dealing hand.

Signatures Admission Committee

  1. Old/New Student.a)Member……………………………..
  2. Eligible/Not Eligible for admission inb)Convener……………………

…………………Class.

Signatures of Dealing Hand.

General Branch.

Recommended for admission/provisional admission in……………………………….

Office Superintendent

Admission granted provisionally subject to confirmation/approval by the Panjab University.

Dean AcademicsPrincipal