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Examination Form for Pg (Md-ms) Courses

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Aastha Agnihotri
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16 views

Examination Form for Pg (Md-ms) Courses

Uploaded by

Aastha Agnihotri
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Himachal Pradesh University

(‘A’ Grade University Accredited by NAAC)


Gyanpath, Summer Hill, Shimla-171005

Roll No._________________
(To be assigned by the office)
Application form for the appearing in MD/MS/MDS ___________________
Examination to be held in __________________20 __________________
Subject in which appearing_____________________________examination.

LAST DATE FOR RECEIPT OF FORM AND FEE: WITHOUT LATE FEE UPTO

i) Examination Admission fee for MD/MS/MDS Regular 6000/- Reappear Rs.


1000/-P.P
ii) With a late fee of Rs. 20000/- in very special circumstances with the due
permission of Hon’ble Vice-Chancellor.

Particular to be filled in by the student neatly and legibly in his / her own handwriting.

1. Name (Block Letters in English)_________________________________


(In Hindi)__________________________ write as per registration card issued by the University.
2. Father’s Name (Block Letters in English)_________________________________
(In Hindi)__________________________write as per registration card issued by the University.
3. Date of Birth________________________________________________________
4. Registration number as per registration card issue by the university_____________
5. Do you belong to Schedule Tribe/ Schedule caste/ Backward Class/Write one specific
category(if apply)______________________________________________
6. Name of the state which you belongs_____________________________________
7. Permanent Home Address______________________________________________

8. Domicile ( for domicile write name of the state)____________________


9. Year of passing the previous professional examination______________
Month ______________Year_________Roll No.__________________
10. Name of college where you are studying_________________________
11. Subject in which appearing:
i._______________________ ii.________________________

iii._______________________ iv._______________________

v._______________________ vi._______________________
12. Subject in which permitted to re-appear:

________________ _________________ __________________


13. For candidate who failed but permitted to re-appear in the subject under examination
under rules:
For first time year________Month_____________Roll No.__________

For Second time year________Month__________Roll No.__________

For Third time year________Month__________ Roll No.___________


14. For failed candidates, yes in which appeared for the first time ________
Month__________________Roll No.___________________________
15. Have you ever been disqualified by any of the university from appearing in any
examination? If so give period for which disqualified.
OR
In any case of unfair means is pending against you? If so, give name of the
examination_______________Year______and Session_________Roll
No._______________(Name of the University Board in which the case in pending)
15. Examination Receipt No. ____________Bank Draft/Cheque No._________

I hereby solemnly declare that the particular as filled in this form as above are true and
correct to the best of my knowledge and belief, if any particular is found false, I shall be
solely responsible for the consequences what so ever.

Signature of the Candidate.


Dated:

Certificate

I, hereby certify that the particulars as filled by the student in this form have been verified
as per record of the college, which are found as correct. I further certify that the aforesaid
student has fulfilled the minimum requirement the condition of the attendance/ lectures as
per H.P University Ordinances and as such he/she is eligible to appear in the examination
to be held in ____________this form has been filled up by the student himself/herself
he/she bears good moral character.

PRINCIPAL
(Signature with seal)
Himachal Pradesh University
Gyanpath, Summer Hill, Shimla-171005
(‘A’ Grade University Accredited by NAAC)

Roll No._________________

Affix one of the

Photograph

Dully attested.
(To be assigned by the office)
Provisional

(To be filled by the candidate)

Admit (Name of the candidate)_______________________________________________

Son/Daughter of Shri.______________________________________________________

To the MD/MS/MDS____________________________________________________

Examination to be held in_____________________20____ on the dates as given in the

date sheet and at centre of Examination________________________________________

Signature of Candidate________________ Controller of Examinations,


Himachal Pradesh University.

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