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PRISMDEGREE & P.G. COLLEGE

(Affiliated to Andhra University)

50-57-1/1, Rajendranagar, Dwarakanagar

Visakhapatnam-16, Ph : 2557711, 2558811

Passport

Size

Photo

Application for Admission into M.Sc / B.Sc. / B.Com. / B.B.M. Courses

Note :

1. Read the Rules and Instructions carefully before filling the Application Form.

2. All entries should be in the candidate's own hand - writing.

3. The Application form which is incomplete or which does not have relevent Certificates is

liable to be rejected.

4. The College reserves the right to cancel the admission of the candidate at any stage, as

and when it is detected that the admission is against the rules.

5. Once admission is given, if discovered that any of the statements made in the application

is incorrect or false, the candidate will be liable for dismissal when ever such discovery

might be made.

6. The candidate seeking admission is to give an undertaking that he/she will abide by the

Rules & Regulations of the College and Andhra University.

Admn. No. Group

Sex : Male / Female

Annual Income : Rs.

Phone : Mobile :

1. Name in full

(Block Letters)

as per SSC or

equivalent certificate

2. Name of the Parent /

Guardian

3. Occupation

4. Mother's Name

5. Address

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( FOR OFFICE USE ONLY )

1. Name of the applicant :___________________________________M / F

2. Total marks secured in the qualifying examination :

3. Group :

4. Second Language :

Order of the Principal : Admit / Reject

Signature of the Princ ipal

CERTIFICATES ENCLOSED

Date :

Signature of the candidate Signature of the Principal

1. SSC or equivalent certificate

2. Inter or equivalent certificate

3. Degree Provisional & Mark Lists

4. Transfer Certificate

5. Caste Certificate

6. Residency Proof Cetificate

7. Income Certificate

8. 4 Photos

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16. Were you a scholarship holder, if so state :

A) Name of the Department which sanctioned :

B) Previous Sanction order no. :

C) Amount of scholarship sanctioned :

17. Do you belong to the State of Andhra Pradesh?

If not, mention the state to which you belong.

DECLARATION BY THE APPLICANT

I hereby state that the above particulars are true to the best of my knowledge. I have read

all the instructions & rules in the application and I promise to abide by the rules and regulations

framed by the college authorities and Andhra University, Visakhapatnam from time to time.

Station :

Date :

Signature of the Candidate

DECLARATION OF THE PARENT / GUARDIAN

Station :

Date : Signature of the Parent / Guardian

I agree to the admission of applicant___________________________in Degree / P.G.

course of your college. I have completely read your college prospectus and

I hereby undertake that my Son / Daughter___________________________________

will obey the rules and regulations laid down in the rules prescribed by Andhra University,

Visakhapatnam. I also ensure applicant's good behaviour during his/her study in the

college and shall be responsible for payment of college fees and other charges duringthe period of study of my son/daughter in the college.

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6. Date of Birth

(Both in words &

figures)

7. Place of Birth :

8. Mother Tongue :

9. Religion :

10. Nationality :

11. Marital Status :

12. Reservation (if any) :

13. Particulars of the Qualifying Exam Passed : First appearance / Supplementary.

Name of the Exam &

College Studied :

Group :

Regd. No. :

Total Marks :

Year :

Class obtained :

14. Second Language Telugu / Sanskrit / Hindi

15. Proficiency in

Games / Sports /

NCC/Extra

Curricular Activities /

Hobbies (Attach

Seperate Sheet

(if necessary)