???? ????? ?? ???? ???? ??? ???/??? ??? ?? ?? ??? ?????? ????? ?????? ?? ???? ??????? FORM IS FILLED IN LEGIBLY WITH BLACK BALL PONT/GEL PEN OTHERWISE APPLICATION WILL BE REJECTED. 1. ????? ?? ??? ??? ??? (Course Code & Name Applied for) ??? (Code) ????? ?? ??? (Name of the course) 3. ??? ???? ?? ???? 1 ? ????? ?? ???? 2 ???? Gender Write 1 for Male and 2 for Female 2. ???????? Date of Birth D D M M Y Y Y Y 10. ?????? ?? ??? (Postal/Local Address ) 11. ??????? ????? ?? ????? (Demand Draft Details) 12. ?????? ?????? (Phone No) 14. ???? (Category) Write 1 - SC 3 - OBC(Uttarakhand) 2 - ST 4 - General 13. ??????? (Nationality) ?????? ?? ????? ??????? ????? ??? (Affix recent Color photograph) ?????? ?? ????????? Signature of the Student ????????-???????-?????????, ?????? FORM No.???? ??????? ?? APPLICATION FORM 4. ?????? ?? ??? (???? ?? ) (???? ???????? ?? ???? ?? ?? ????? ??) 5. Name of the Student (In English USE CAPITAL LETTER ONLY) (Should be filled according to High School or equivalent certificate) 6. ????/??? ?? ??? (???? ?? ) 7. Father's Name/Husband's Name (In English Use CAPITAL LETTER Only) 8. ???? ?? ??? (???? ?? ) 9. Mother's Name 15. ??????? ??????? ?? ???????? ?????& (Complete Academic Detail) Degree Subjects Year Marks Obtained Max Marks %age Roll No University ???? Graduation(10+2+3) ????? ?? ???/??/?????/....................................................????????? ????? ????/???? ??? ?? ???? ???? ?? ??? ????? ??????? ????? ??? ? ????? ??? ??? ???? ??? ???? ????? ???? ???? ?? ?? ???? ????? ?????? ??? ???? ????? ????????? ??????/????????? ???- ????? ????? ?? ??? ??????? ??? ???? ??? ?? ???? ?? ???? ? ???? 1. Course Code & Name Applied for FORM NO (In English CAPITAL LETTER Only) (???? ?? ???? ??? ??? ????) 2. Name of the Student 3. Father's/Husband's Name 4. Mother's Name 5. Date Of Birth 6.Gender (Mark T ) Male Female 7.Category Code 8. Postal/Local Address 9. Permanent Address (As per Column 14) 10.Phone No 11.Nationality ?????? ?? ????? ??????? ????? ??? (Affix recent Color photograph Here) Do not pin or staple. Do not sign Or mark on photo. (As per Column 1) ??? ?????? ????? ?? ??? ??? ?????? ????? ?? ??? ??? ?????? ????? ?? ??? 01 ????????? 03 ??????? ?? ?????? ???????? 05 ????????? ????????? ?? ?????? ???????? s ssa h h sa h h f s f f f f f ????? ??????.............................................................??? ?? ???...................................................?????............................ ???..................................
