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Form A

D.A.V. College, Chandigarh


Sr. No. ..........................

Application Form for Admission


2012-2013
For Office Use Only
Application Form
Received on............
Signature of Receiver ...............

www.davchd.com

Class Section..Roll No.


Amount received RsReceipt No...Dated

CLASS/PROGRAMME YOU WISH TO JOIN: .......................


Result of Previous Year: Pass/Fail/Compartment:
Category/Categories against which application is being submitted (Put mark in the relevant box):
General

Defence Personnel quota

Scheduled Caste

Terrorist Victims

Sports Persons

Freedom Fighters

*Physically Handicapped/VH/blind
Widows/Divorced
Women

Kashmiri Migrants
Foreign National
NRI
Industry Sponsored
Single Girl Child

For admission to M.Sc.-I in Phy/Chem/Zoo/Bioinfo/Biotech/MBE


Whether appeared in O-CET conducted
by P.U. the

right box
Yes

No

If Yes, marks obtained _____________ Rank ________________


50% of the marks obt. in O-CET ___________________________
50% of the marks obt. in B.Sc./BA/B.Com___________________

Panjab University Registration Number (if any)


Panjab University PUPIN (11 digit identification Number, if any)

PASTE YOUR
PHOTO HERE
DO NOT
STAPLE
U.T. Pool
General Pool
Are you claiming
any weightage : Yes/No

1.

Name of the applicant (in block letters): (as in tenth class certificate) (Leave one blank space between parts of Name)

2.

(a) Fathers Name (in block letters) (As in tenth class certificate)

Occupation : ____________________________ Position/Designation _____________________ Office Address_______________________


_______________________________________Phone No.______________________________ Mobile No. __________________________
(b) Mothers Name (in block letters) (As in tenth class certificate)
Occupation : ____________________________ Position/Designation _____________________ Office Address_______________________
_______________________________________Phone No.______________________________ Mobile No. __________________________
(c) Guardians Name (if applicable):
Occupation : ____________________________ Position/Designation _____________________ Office Address_______________________
_______________________________________Phone No.______________________________ Mobile No. __________________________
3. Annual income from all sources Rs.
(For availing half fee concession admissible to students whose parents' income is not more than Rs. 1,00,000 p.a. attach documentary proof.)

4.
6.

Date of Birth:
5.(a) Sex(M/F)
5.(b) Blood Group
Birth Particulars : (i) Place __________________________________ (ii) District__________________________________________
(iii) State__________________________________ (iv) Nationality ______________________________________
7. Full address for correspondence: _________________________________________________________________________________
___________________________________________________________________________________Mobile No.__________________
Telephone No. _______________________ Pin Code: _________________E-mail Address ________________________________
8. Permanent Home Address: _____________________________________________________________________________________
___________________________________________________________________________________Mobile No._________________
Telephone No. ______________________ Pin Code: _________________E-mail Address _________________________________
(Attach photo copy of Residence Proof)
9. Subjects/options you want to study (Please refer to Prospectus.)
(i) _______________________ (ii) ___________________________(iii) ________________________ (iv)__________________________
(v) ______________________ (vi) __________________________ (vii) _______________________ (viii) ________________________
(ix) _____________________(x) __________________________
9.(a)*Please write optional subject: (For B.Com. IIIrd year)
(1. Operational Research (OR) or 2. Organisational Behaviour) (OB) :____________________________________________________
9.(b)*For all students of Ist year: Please fill as per eligibility (see prospectus)
(1. HCP or 2. Punjabi) : _______________________________________________________________________________________
* 9.(a) & 9.(b) are mandatory

10. Subjects of Hons, you wish to opt for (for B.A. / B.Com. students) ___________________________
(Students are required to fill up the attached form for Hons subjects)

11. Previous class details: Session _______________Class ______________Roll No.______________


(For old students of the College)

12. Have you passed in English in class XII exams?


Yes/No.
13. Add-on subject you wish to study (for under graduate students only)_______________________

For B.A.
Subject combination
No. as given in the college
prospectus on
page no. 17

(Certificate/Diploma Level)

14. Mention gap years, if any. (Furnish affidavit explaining gap) ___________________________________________________________
15. Have you ever been punished for misbehaviour or for using unfair means? If Yes, give details. ________________________________
_______________________________________________________________________________________________________
16. Have you ever been disqualified by any Board / University? If Yes, give details. ___________________________________________
_______________________________________________________________________________________________________
(No candidate is admitted under any circumstances during disqualification period)
17. Are you migrating from another college / University? If Yes, give details. ________________________________________________
__________________________________________Migration Certificate attached?
Yes/No
18. Do you suffer from any serious ailment? If so give details including details of treatment. ____________________________________
_______________________________________________________________________________________________________________
19. For Foreign Students Only (Attach photostat copy of passport, duly attested and Eligibility Certificate from Panjab University)
(a) Nationality _______________________________________ (b) Passport No. ____________________________________________
(c) Visa valid upto ____________________________________(d) Resident Permit _________________________________________
20. Result of Previous Class.
Pass/Fail/Compt.
21. Compartment in the subject of _______________________________________________________

DECLARATION BY THE APPLICANT AND THE PARENTS/GUARDIAN


1.

2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.

I declare that I have carefully read the instructions and state that the entries made by me in this form are correct to the best of my
knowledge and nothing has been concealed. I understand that my admission is liable to be cancelled if any of the statements made by
me is found incorrect.
I undertake to observe proper standards of academic conduct and not to associate with any activity that goes against the discipline of
the College.
I shall abide by the rules and regulations of the College and the Panjab University.
I shall faithfully carry out the instructions issued by the College authorities from time to time.
I hold myself responsible for due and prompt payment of fees and all other dues.
I understand that I cannot concurrently be enrolled for more than one full-time course of studies.
I am fully aware that ragging, smoking and drinking liquor is strictly prohibited in the College/Hostel. If I am found guilty of indulging in
these activities, I shall be liable for punishment and expulsion from the Hostel/College.
I solemnly state that I am not facing any disciplinary proceedings and have not been disqualified by any Board/University.
I have not so far been admitted to any affiliated College/Dept. of the Panjab University in the class to which I am seeking admission.
I shall not smoke and drink in and around the College.
I shall not use mobile phone in the College.
I shall fulfil the requirements of the Panjab University i.e. is 75% attendance of the lectures and 25% marks in House tests.
I solemnly declare that the certificates submitted by me along with this application are true and have not been tampered with. I
understand that my admission is liable to be cancelled if any of the certificates is found to be false.

Date..................................

...............................................................
(Full Signature of the Candidate)

I certify that my son/daughter/ward is making this application with my permission. I hold myself responsible for his/her good conduct and
behaviour as a student of the College and for payment all his/her dues during his/her stay in the College. I undertake responsibility that my
son/daughter/ward will attend the classes regularly and punctually to complete the required percentage of attendance as per the Panjab
University rules, failing which I understand that he/she will be rendered ineligible for the final examinations.
Date ...................................

.............................................................
(Full Signature of the Parent/Guardian)
Name...........................................................................
Address........................................................................
.....................................................................................
.....................................................................................

Note:
1. Applicant is require to fill Form A and Form C (for new student) and Form A, Form B and Form C (for old student)
2. Incomplete application or with wrong/deliberately concealed information is liable to be straightaway rejected.

INSTRUCTIONS FOR CANDIDATES


1.
2.

3.

4.
5.
6.

This form must be filled by the candidate in his or her own hand in a clear and legible manner.
This application form complete in all respects must be submitted to the College office as has been indicated in the Admission Notice
as well as in the Prospectus on or before the last date indicated, even if the result of the qualifying examination has not been
declared.
The application form must be completed in all respects. No column should be left unfilled. If any Information sought is not applicable
to the candidate the word "NA" should be entered against this column. If a candidate omits/conceals relevant information or gives
false information, his/her admission is liable to be cancelled.
Attested copies of Board/University Certificates, Certificates claiming special status, etc. must be attached to this application form.
In case the required documents are not attached, the application is liable to be rejected as incomplete.
The declaration to be made by the candidate and his/her parent on page 3 should be signed and dated before the application is
submitted.
All certificates/documents submitted by the candidate with this form must be signed by the candidate himself/herself also.

Note:

THE CANDIDATES SHOULD UNDERSTAND THAT THE ADMISSION IF GRANTED BY THE COLLEGE WOULD BE PROVISIONAL AND
SUBJECT TO CONFIRMATION BY THE UNIVERSITY.

DOCUMENTS TO BE SUBMITTED WITH APPLICATION FORM


Submit the following documents and put in the box.
1.

Attested copies of Board or University Certificates showing the date of birth and details of previous examinations passed
and detailed marks certificates. (Original Detailed Marks Certificate issued by the University or the Board should be
produced at the time of interview.)
2. An attested copy of the certificate of good conduct from the Head of the Institution last attended.
3. Three copies of recent passport size photograph. (One pasted, two stapled).
4. The students will have to submit a personal affidavit about their marks to the college in case their result gazettes are not
available with the college.
5. Original Migration Certificates in case of candidates seeking admission to the college from
Universities/Boards/Councils/Bodies other than Panjab University. Migration Certificate can be submitted latest before
th
th
20 September, 2012 because it must reach the Panjab University Office by 30 September, 2012. Candidate seeking
admission to Diploma/Certificate courses will submit No Objection Certificate from the parent University/Institution in
place of Migration Certificate.
6. Certificates relevant to claim any reserved category status.
7. Affidavit explaining gap year/years, if any.
8. Certificates in support of claim for weightage/weightages.
9. Eligibility certificate.
10. Foreign students are admitted if they have eligibility certificate from Panjab University and a long term visa.
11. An attested photo copy of residence proof.
12. Any Other ____________________________________________________________
TOTAL NUMBER OF DOCUMENTS SUBMITTED _________________________________

Percentage of Marks
obtained

Division

Subjects

Marks obtained out


of Max. Marks

Detail of Marks
Percentage of Marks

Total Marks obtained


out of Max. Marks

Pass/Fail/Compt.

Name of
university/
Board and
Roll No.

Session

Examination

School/College from
which appeared

ACADEMIC RECORD

Matric / Class X

XIIth Class Exam,


under 10+2 or
its equivalent

B.A./B.Sc./B.Com./
BBA/BCA Part-I

B.A./B.Sc./B.Com./
BBA/BCA Part-II

B.A./B.Sc./B.Com./
BBA/BCA Part-III

B.A. (Hons.)
B.Sc. (Hons.)
B.Sc. (Hons. School)
B.Com. (Hons.)
st

M.Com/MBE 1 Sem.
nd
2 Sem.
rd
3 Sem.

M.A./M.Sc. Part-I

Any other Exam.

Signatures of the Applicant

Admission Remarks
Percentage in the previous exam :
Deficient in the subject of :
Documents required :

Prof. in-charge

Dean Admission

Principal

ACKNOWLEDGMENT
Application form Serial No. :______________________________________________
Received from : _______________________________________________________
Application form for class/programme: _____________________________________
Receipt No. : __________________________
Dated : ______________________________

Signature

(To be submitted along with Admission Form by students already registred with Panjab University, Chandigarh)

D.A.V. College, Chandigarh


(PANJAB UNIVERSITY ANNUAL EXAM. APRIL 2012)
(Subject to final confirmation of eligibility of candidate)

College Roll No. _______________


(for office use)

Class: ____________________________________________
Subjects: _________________________________________
________________________________________
PUPIN NO.
Name : ___________________________________________________
Fathers Name : ____________________________________________
Mothers Name: ____________________________________________
Centre Exam.: CHANDIGARH
Centre No. (For office use only): _______________________________ (Full Signatures of Candidate)

Controller of Examinations

Principal

Note : This card must be shown to the invigilating staff with PUPIN Card at P.U. Exam. For April,2012 Examination.

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