1303196_eflu_application_2013_4

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THE ENGLISH AND FOREIGN LANGUAGES UNIVERSITY

HYDERABAD - 500 007

Application for Admissions 2013-14

Application No. : 1303196

1. Name of the candidate : RAHUL KUMAR

2. Date of Birth : 09-08-1996

3. Name of the father : RAM BAHADUR SAW

4. Name of the mother : KARUNA DEVI

5. Present Address : Address - ROOM NO-304, SATLUJ BOYS HOSTEL, JAWAHAR LAL NEHRU

UNIVERSITY, NEW DELHI

City - NEW DELHI

Pincode - 110067

State - DELHI

6. Permanent Address : Address - VILL-RAJPUR POST-LOSHGHANI, DIST- LAKHISARAI

City - LAKJISARAI

Pincode - 811112

State - BIHAR

7. Tele No with STD code : 8. Mobile No. : 7579192305 9. E-mail : [email protected]

10. State of Domicile : Bihar

11. Category : OBC

12. Ward of Defence Personnel (Y/N) : : NO 13. Displaced Kashmiri Migrant : NO

14. PWD (Visually/Physically Challenged persons) : NO PWD Type : --

15. Programme Name : B A (Hons.) 16. Subject : Foreign Languages

17. Subject preference 1 : Japanese Subject preference 2 : Spanish

18. Test Centre 1st Preference : Delhi Test Centre 2nd Preference : Gaya

19. Name of the Campus : HYDERABAD

20. Position regarding qualifying exam : RA

21. Do you belong to any minority community (forstatistical purpose only)

: NO

22. Payment Detail

Mode of Payment : State Bank of India Challan

DD/Challan Journal No. : 013976929 Date : 2013-04-20

Bank : DEHRADUN Branch : DEFENCE COLONY Amount : 350.00

23. Academic record from SSC (X standard) onwards (Enclose copies of certificates)

Examination Passed /

Course

Name of the Board

/UnivSubjects Taken

Year of

Passing

Total Marks

Max. MarksMarks

Obtained% of Marks

MATRIC BSEB PATNA MATH SCIENCE

SSCIENCE SNK HINDI

ENG

Apr-2011

500 358 71.6

INTER BIEC PATNA MATH PHYS CHE

HINDI

ENG

May-2013

24. Is there any gap in your studies? : NO

25. If applying for Ph.D. programmes

a) mention topic of research. (Submit TEN copies of the research proposal in the stipulated format at the time of the interview) :

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b) Have you passed the UGC JRF NET? : --

26. Do you require Hostel Accommodation? :YES

27. Have you ever been subjected to disciplinary action by any authority? :NO

If yes, give details :

28. Any other information such as publications/excellence in sports/music, etc.( attach separate sheet if needed) Please specify :

29.a) Have you done an M.Phil./M.Litt. degree from CIEFL/EFL University? :--

30. DECLARATION BY THE APPLICANT: I hereby declare that all the information furnished by me in this application and in the

documents I have submitted in support of my application is true, complete and correct. In case any information in this application isfound to be false or incorrect at any t ime (during or after completion of the course), it shall entail automatic cancellation of my

admission if granted, cancellation of the degree if awarded, besides rendering me liable to such action as the University may deem fit.

In the event of any medical or other emergency, my parent/s or guardian may be contacted at the address given below.

Place:

Date:

Affix your recent passport size colour

photograph duly attested by a

Gezetted officer.

31. DECLARATION BY FATHER/MOTHER/GUARDIAN: My daughter/son/ward Mr./Ms. RAHUL KUMAR is applying for admission to

the EFL University. In case of her/his admission to the University, I shall be responsible for payment of all her/his fees and other

charges including medical insurance. Should there be any medical emergency, I shall be responsible for the payment of all such

medical expenses that may not be covered by medical insurance. In case any information in this application is found to be false or

incorrect at any time (during or after completion of the course), it shall entail automatic cancellation of my daughters/sons/wardsadmission if granted, cancellation of the degree if awarded, besides rendering her/him liable to such action as the University may deem

fit.

I will also be responsible for her/his good conduct and behaviour during the period of her/his stay in the University. Further, I may be

contacted in the event of any emergency as determined by the University and I hereby promise that I will make myself present before

the University authority at my own cost whenever the University requires my presence.

Fathers Occupation : GOVT EMPLOYEE Annual income Rs : 150000

Mothers Occupation : HOUSE WIFE Annual income Rs :0

Signature of the Parent/Guardian

Place: Full Name:Date: Relationship with the applicant:

Note: Signature of the parent/guardian in this application form will be considered the basis for all verification purposes in the

University.

Checklist of Enclosures:

1. Date of Birth Certificate (SSC / X Class Standard certificate)

2. Intermediate Certificate and Marks memo (for B.A. (Hons.) programmes)

3. Degree Certificate (provisional Certificate in case the Degree Certificate has not been issued)

4. Degree Examination Marks Memo(s)

5. Masters degree/Provisional Certificate

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6. Masters degree Marks Memos

7. Community and Income Certificate (in the case of SC/ST candidates - issued by Competent Authority)

8. Non-Creamy Layer Certificate for OBC candidates in GOI proforma

9. Medical Certificate from a Civil Surgeon (in case of PHC/VHC candidates)

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1303196_eflu_application_2013_4

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