re-admission - cum examination form

CHAUDHARY DEVI LAL UNIVERSITY, SIRSA

(University Centre for Distance Learning)

Re-admission-Cum-Examination Form2014-2015

(For next higher Class)For Annual System

Last Date for submission of form: 31st December, 2015 (Normal Fee) With Late Fee of Rs. 500/- : 15th February, 2015 With Late Fee of Rs. 900/- : 31st March, 2015

For Semester System

Last Date for submission of form : 14.10.2015(Normal Fee With Late Fee of Rs. 500/- : 31.102015 With Late Fee of Rs. 900/- : 15.11.2015Note: The admission fee is the same as per last year(s).

Registration No. ____________1. Name of program/Course applied for…………………………………………………………………………..

2. Name of the Candidate………………………………………………………………………………………………….

3. Male/Female………………………………………………………………………………………………………………….

4. Father’s/Guardian’s Name……………………………………………………………………………………………

5. Mother’s Name……………………………………………………………………………………………………………….

6. Date of Birth……………………………………………………………………………………………………………………

7. Nationality………………………………………………………………………………………………………………………

8. Mailing Address……………………………………………………………………………………………………………..

………………………………………………………………………………………………………………………………………………..

9. Permanent Address……………………………………………………………………………………………………….

………………………………………………………………………………………………………………………………………………….…

10. Telephone with STD Code/Mobile No…………………………………………………………………………..

11. Details of Previous Course/Class :

Exam Passed/

Appeared

Session Roll No. Marks

Secured

Max.marks Re-appear in the

papers

Paste Latest

Passport size

Photograph

Paste Latest

Passport size

Photograph

12. Crossed Bank Draft/University Receipt no…………………………for Rs………………….………….…….

Dated………………….…….drawn from…………………………….………….bank in favour of Registrar,

Chaudhary Devi Lal University, payable at Sirsa (Haryana). Candidate is advised to write his/her

name,address and name of course applied for on the backside of the Bank Draft

13 List of documents attached:

1.

2.

3.

_ _ _ _ _ _ _ _ _ _ _ _ _

Date……………………. (Signature of the candidate)

Place …………………………….

(FOR OFFICE USE ONLY)

Eligible for Promotion Not Eligible

Deficiency if any ………………………. Reason……………….

Checked by: Clerk Assistant Superintendent (UCDL) A.R. (UCDL)


University Centre for Distance LearningINFORMATION FOR COMPUTER USAGE

TO BE FILLED IN ENGLISH AND IN BLOCK LETTERS ONLY

Registration No. ____________

1. Name of Examination:

Paste Latest

Passport size

Photograph

2. Part: First/Second year

3. Name of Candidate

4. Father’ Name

5. Mother’s Name

6. Permanent Address: (Name/Father’s Name May not be mentioned here

Pin Code:

District

State

Signature of t he Candidate

7. Contact Number

8. Sex Code:

9. Area Code: Rural/Urban

10. Married (M)/Unmarried (UM)

11. SC/ST/BC/Physically Challenged:

12. General (G):

13. Employed (EM) /Unemployment (UEM):

14. Subjects Papers

1

2

3

4

5

6

7

8

9

10

15. Previous Roll No. (if any)

16. Session of last exam:

17. Result

18. Medium

Serial No. ……. 1

H E

M F

CHAUDHARY DEVI LAL UNIVERSITY, SIRSAExam Form For Fresh/ Supplementary /Ex-students Examination

(Incomplete Admission From will not be entertained)

TO BE FILLED IN ENGLISH AND BLOCK LETTERS ONLYRoll No. Registration No.

(To be allotted by the University)

1. ( i ) Name of Course/Examination (ii) Part/Semester

(iii) Course Code

2. (i) Date of Birth

Signature of Candidate (Within Box)

Note: Name & Particular must be the same as have been shown in the certificate of 10+2 examination or in the

DMC of Graduation.

3. Appearing in Category Full (F) Reappear (R) Improvement (I) Additional Subject (A)

(Attach Photocopy of DMC for eligibility)

4. Examination Centre Code of Centre

5. Name of Student in English (Block Letters)

6. Father’s Name SHRI

7.Mother’s Name

SMT.

Affix Your Photo

within box

8. (i) Address (Do not write name or Father’s Name)

(ii) State to which you belong Contact no.

9. Sex Code (M/F) 10. Medium English (E) Hindi (H).

11. BC/SC/ST/Handicapped (PH), General (GE) or Blind (BL)

12. Current Examination Subject Codes Subject / Papers in which appearing

SubjectCode

13. The Reappear candidate must fill up the column for each availed chance. (i) Information of Lower/Higher Examination/Reappear result of the same class.

Name of Exam.

Chance availed

Year &

Session

Roll No. Result University

14.Are you appearing in any other examination from this University or any other University simultaneously. Write ‘Yes’ or ‘No’ in the box15. If answer to Item No. 14 is ‘Yes’ write Particulars of all such exam. below.

Name of Class University / Board Subject in which to appear Full Subjects/Re-appear /

16. Have you ever been disqualified in any exam. or any UMC Registered against you, if yes, give detail.

University/ Examination Year & Roll No. Punishment

17. University Fee Receipt No./Bank Draft No. …………………….Dated…..………….Amount.…………

17. For Improvement candidates only

PIN

(i) Session & Roll No. for passing final .Examination

(ii) Chance availed

Final

Previous

DECLARATION I solemnly declare that the particulars filled in by me in the above columns are correct and nothing has been concealed therein. In case of any discrepancy/concealment found therein, I shall be responsible for the consequences.

Dated : ……………..

Place : …………….. Signature of the Candidate

ATTESTATION (Certificate to be signed by the attesting authority)I Certify that……………..………………S/o. D/o. Shri…………..………………..appeared in ……………………….under Roll No………………..and failed/placed under Re-appear/passedHe/She bears a goods moral character and has signed this form in my presence.

Full Name of the Attesting Officer …………………………Designation & Full Address of attesting authority………………………………………………………………………………………………………………………………

Dated : Signature of Attesting Authority(With Seal)

REMARKS BY UNIVERSITY REGARDING ELIGIBILITYEligibility Checked from Result-sheet/Gazette/Original Documents (Please Tick Mark) as under: -

Eligible Not eligible

(i)Name of Exam/Session ………….(ii)Roll No…………. ( i)Name of Exam/Session ………..(ii)RollNo…………

( iii)Result………….. …….. (iii)Result……………………

Eligible subject to Production of ……………………… Not eligible with reason…………………….

Clerk Assistant Superintendent. Clerk Assistant Superintendent.

. (Final Order, if eligible) Asstt. Register (if not eligible)

Class Session Roll No.

.

PROVISIONAL 3


ROLL No. SLIP

Regn.No……………… ROLL NO. ……………

(To be assigned by the Office)

Name of Exam ………………………………………………….

1. Admit (Name of the Candidate) …………………………….…...

2. Father’s Name Shri ………………………………………….….

3. Mother’s Name Smt. ……………………………………………

4. Centre of Exam. ……………………Centre No. ……………….

5. Subject in which appearing

1.…………….……..2...…..……………...3. .…….………….

4. …………………...5. …………………..6. ………………...

Signature of the Candidate ………………………………………

(The candidate must sign. here before submitting this form to the University) Controller of Examination

_____________________________________________________________________________________

TO BE FILLED IN BY THE CANDIDATE


(For Centre Superintendent)

1. Roll No. ……………………………Name of Exam. ……………………..

2. Regn. No. ………………………………………………………………….

3. Name of Candidate ………………………………………………………..

4. Father’s Name Shri ………………………………………………………..

5. Mother’s Name Smt. ………………………………………………………

6. Signature of the Candidate ………………………………………………..

Space for latest Photo of the

Candidate Male or Female duly

signed and attested by the attesting

authority

1. Address for Correspondence

Class……………...Regn.-Cum-Roll No. ……………...

Name………………………………………

Address……………………………………………………………

…………………….Phone No…..…………Pin…………..

……

1. Address for Correspondence

Class……………...Regn.-Cum-Roll No. ……………….

Name………………………………………..Address…………

…………………………..………………………………………………

Phone No…..…………Pin…………..……..

Space of Affixing Attested

Photograph

Chaudhary Devi Lal University, Sirsa 4

INFORMATION FOR COMPUTER USAGE_ ____

TO BE FILLED IN ENGLISH (BLOCK LETTERS ONLY)

REGN. No. Roll. No.

1. Name of Examination Exam code

2. Appearing in Category Full (F)/Reappear(R)/Additional(A)/Improvement ( I )

3. Examination Centre

4. Name of Candidate

5. Father’s Name: SHRI

6. Mother’s Name SMT

7. Correspondence Address

Pin Code

Contact No.

8. Sex Code

9. U.C.D.L. Reference No./College RollNo.

10. SC/ST/BC/Handicapped (PH), General (GE), Blind (BL)

11. Papers Codes in which appearing

12. Medium Previous Roll No.

13. Session of Last Exam RESULT

14.Signature of the Candidate

Signature of the attesting Authority(With Seal)

F R A I

Affix unattested photo

M F

E H

(For Office Use Only)15. Diary No.………………… 16. Amount Received …………………………… Date………………………..Univ. Receipt No. ……………..Dt. ………………………….17. Checked by University officials