PEERZADA MOHAMMAD 1. Name Affix Self BASIM Attested PEERZADA KHURSHID AHMAD Passport Size 2. Father's Name Photograph 3. Regd. No 256-BS-2015 4. (i) Date of Birth (dd/mm/yyyy)
(ii) Place of Birth 5. Nationality
6. Permanent home address
7. Address for correspondence
8.(i) District (ii) Cell No (iii) Phone No
9. Whether a permanent resident of J&K State (Yes / No)
10. Occupation of Father/Guardian
11. Are you presently on the rolls of any Deptt. of this University. If yes, indicate the name of the Deptt
12. State the particular category if selected under any of the reversed categories 13. Academic Record
Name of the Year of Marks % age Division/ Regd.No College/Institution
Exam. Passing Obtained Distinction through which passed
12th
Graduation (Aggregate)
Any other
14. Do you want to reside in the hostel ( Yes / No )
I solemly declare/undertake that;
i) The particulars given above are correct. ii) I will obey all the statutes /regulations related to admission and also the instructions that may be issued from time to time by the University in this behalf. Any violation of the statutes and regulations of the University by me shall render me liable to such punishment, disciplinary action, including cancellation of admissions, as the University authorities may impose on me. iii) I am not serving in any Govt/Semi-Govt/Private institution or concern nor shall I serve or join any appointment during the tenure of the present program in the University. iv) I am serving in the Department _________________________________________________ as a _____________________________________________ and have obtained permission of my employer for joining the course / programme in the University . vi) I am not enrolled for any other course in any other Department of this University or any other University. Date Signature of the applicant Form No: ADU-1511036 Declaration by Parent/Guardian
I am responsible for the conduct of my ward namely PEERZADA MOHAMMAD BASIM in the University and undertake to pay his/her dues and bear his/her expenses on books, tours and excursions. I am liable to make good any loss or damage to the University property which may be caused as a result of misconduct of my ward.
Date: Sig. of Parent/Guardian
Name:__________________________
Address:________________________
Note: The Candidtes must approach the concerned Department and obtain permission from HOD for depositing the fee in the Bank. THE UNIVERSITY OF KASHMIR Hazratbal Srinagar-190006 Form No: ADU-1511036
To be sent to the Dean Students Welfare by the Department after the completion of admission process.
1. Name PEERZADA MOHAMMAD BASIM
2. Father's Name PEERZADA KHURSHID AHMAD
3. Department
4. Date of Admission
5. Class Roll No 6. Registration No 256-BS-2015
7. Permanent home address
8. Address for correspondence
District Contact No
9. Date of Birth
10. Academic Record
Name of the Year of Marks % age Division / Regd.No College/Institution
Exam. Passing Obtained Distinction through which passed
Dated
Signature of the applicant
Forwarded in original to the Dean, Students welfare with the report that the candidate in question has completed admission formalities and has deposited all the dues in the University Chest.
Signature of the Head of the
Dated Deptt.with official seal
Department:
Received Annual Student's Magazine and Identity Card bearing No
Signature of the Students
UNIVERSITY OF KASHMIR, SRINAGAR FOR THE USE OF CHIEF PROCTOR 'S OFFICE Form No: ADU-1511036 CARD INDEX NO: YEAR/SESSION: Integrated MBA Course Admitted to Faculty
1. Name of the student PEERZADA MOHAMMAD 2. Father's Name PEERZADA KHURSHID
BASIM AHMAD 3. Father's Profession 4. Gender : Male / Female
5. Date of Birth 6.Semester 7.Roll No
8. Contact No (a) Candidate's (b) Parent's
(c) Local Aquaintee's / other contact No
9. Examination passed before Joining the University Exam / Class Year Marks Obt. %age Roll No Category School / College
12 th Graduation (Aggregate)
Any Other 10. Examination passed after Joining the University Session Class Year Roll No Marks Obt. %age Semester Aggregate Marks
11. Hostel Records
(a) Name of the Hostel Admitted to (b) Date of Admission (c) Room No (d) Permanent Home Address
I certify that every detail provided by me in this format is true to the best of my knowledge.
Signature of Students /Date
Signature of HOD / Date Signature of Chief Proctor / Date
Conduct Record of the Student (For Office Use Only)
S.No. Details of Episode Date / Year Final Report / Status Sign. of IO Sig. of CP
Details of Issuance of Conduct Certificate
Receipt No Date Sign. of Clerk Sign. of Sign. of Sign. of
/ SO Proctor DCP CP
Note:- This duly filled format is required to be submitted at the office of the Chief Proctor within fifteen days after completing admission at the department.No form will be entertained thereafter. This fee slip is to be deposited at directorate of IT&SS
The Jammu and Kashmir Bank Limited
IT&SS Copy Dated: 09-Mar-2019 Form No ADU-1511036 Name : Parentage: PEERZADA KHURSHID AHMAD PEERZADA MOHAMMAD BASIM Address: Mobile:
The Jammu and Kashmir Bank Limited Students Copy Dated: 09-Mar-2019 Form No ADU-1511036 Name : PEERZADA MOHAMMAD BASIM Parentage: PEERZADA KHURSHID AHMAD
Bank Copy Dated: 09-Mar-2019 Form No ADU-1511036 Name : PEERZADA MOHAMMAD BASIM Parentage: PEERZADA KHURSHID AHMAD
Address: Mobile:
Purpose: Account No: Amount (Rs)
Part A 0007040500001001 2800
Part B 0007040100010301 7750
Part C i) Library Fee 0007010100000268 800
ii) Chief Proctor 0007040100017274 200
iiI) Internet Fee 0007040500001126 300
iv) DSW Fee 0007040100013798 75
Sign. of Depositer Bank Seal & Signature
Mr/Ms bearing E n t r a n c e Te s t Roll No 1 5 0 3 7 111 0 3 6 selected for the program in the Dept . of________________________________________________ is authorized to deposite the admission Fee. Signature of the Head of the Department with official seal The Jammu and Kashmir Bank Limited Library Copy Dated: 09-Mar-2019 Form No ADU-1511036 Name : Parentage: PEERZADA KHURSHID AHMAD PEERZADA MOHAMMAD BASIM Address: Mobile:
Mr/Ms bearing E n t r a n c e Te s t Roll No 1 5 0 3 7 111 0 3 6 selected for the program in the Dept . of________________________________________________ is authorized to deposite the admission Fee. Signature of the Head of the Department with official seal
Notes: (1) Additional Rs 5/= to be paid as Bank Charges (2) Fee can be deposited at any branch of J & K Bank Ltd.
The Jammu and Kashmir Bank Limited
Banks's Copy Dated: 09-Mar-2019 Form No ADU-1511036 Name : PEERZADA MOHAMMAD BASIM Parentage: PEERZADA KHURSHID AHMAD Address: Mobile:
Purpose: Account No: Amount (Rs)
Part B 0007040100010301 7750
Sign. of Depositer Bank Seal & Signature
The Jammu and Kashmir Bank Limited
Student's Copy Dated: 09-Mar-2019 Form No ADU-1511036 Name : PEERZADA MOHAMMAD BASIM Parentage: PEERZADA KHURSHID AHMAD Address: Mobile:
Purpose: Account No: Amount (Rs)
Part B 0007040100010301 7750
Sign. of Depositer Bank Seal & Signature
The Jammu and Kashmir Bank Limited
Univserity's Copy Dated: 09-Mar-2019 Form No ADU-1511036 Name : PEERZADA MOHAMMAD BASIM Parentage: PEERZADA KHURSHID AHMAD Address: Mobile:
Purpose: Account No: Amount (Rs)
Part B 0007040100010301 7750
Sign. of Depositer Bank Seal & Signature
Mr/Ms bearing EntranceTest Roll No selected for the program in the Dept. of________________________________________________ is authorized to deposite the admission Fee.
