MAYURBHANJ LAW COLLEGE
TAKATPUR, BARIPADA, ODISHA
(Affiliated to North Orissa University)
INDEX NO.
ROLL NO.
SL. NO.
APPLICATION FORM FOR ADMISSION IN TO 1 ST YEAR (3yrs LL.B.) COURSE
OFFICE USE ONLY
Total Marks
Obtained
FOR APPLICANT
Total Mark
Sign of D.A.
Mark Secured
One Stamp size
photograph signed by
the applicant on the
front (to be affixed)
1.
Name of the Applicant (IN BLOCK LETTERS)
2.
Sex: Male/Female
4.
Married/Unmarried
6.
Date of Birth (As recorded in High School Certificate) IN FIGURES ________________________________________
3.
Religion ___________________________________
5.
Nationality _________________________________
IN WORDS ____________________________________________________________________________________
7.
______________________________________________________________________________________
Blood Group
8.
(a) Land Phone No. __________________________
(b) Mobile No. _________________________________
9. Address of the applicant for correspondence:
Name:
Vill:
P.O.:
Via:
Dist.:
Pin:
Tel. No.:
POST CARD
To be detached and
sent as Index Card.
Full Present Postal
address to be written on
this Index Card
To
From:
PRINCIPAL
Mayurbhanj Law College
BARIPADA
Affix
Stamp
10. Mention whether Schedule Caste/Schedule Tribe ___________________________________________________
(a certificate to this effect from the competent authority must be attached)
11. Municipal Areas/Rural Area ___________________________ 11. Home District __________________________
12. Parental Information:
13.
i)
Name of Mother
Occupation
ii)
Name of Father
Occupation
iii)
Name of Guardian
(if other than father)
Mobile
Phone No.
Mobile
Phone No.
Mobile
Phone No.
Occupation
Full Address of Father/
Guardian/Local Guardian
PERMANENT ADDRESS OF CORRESPONDENCE
FATHER
GUARDIAN
Name:
Vill :
P.O. :
Via. :
Dist.:
Pin:
Tel. No.:
INDEX CARD
The undersigned acknowledge the receipt of your application for admission
into 3 yrs. LL.B. course.
You have assigned Index No ________________________
You are required to quote this No. in all your correspondence regarding
admission, otherwise your query cannot be replied.
NOTE : The present postal address to which this Index is to be sent must
be written in the reverse by the applicant.
PRINCIPAL
Mayurbhanj Law College, Baripada
(To be detached and
sent as Index Card.)
14.
Name of the Institution last attended. : __________________________________________________________
15.
PHYSICAL DEFICIENCIES OF DISABILITY IF ANY: Yes/No
16.
Educational Bio-data:
Sl
No
Examination
Passed
Division/
Grade
Year of
Passing
Name of the Educational
Institution
Mark
Secured
University
Subject
Taken
17.
University Registration No. ________________________
18.
Are you a Government Servant YES/NO _____________
(If so permission from the competent authority in original should be attached)
19.
If admitted, I propose to reside with my parent/Natural/Recognised Guardian/in a College Hostel/in a
Recognised Hostel or Mess.
20.
Any Special claim for weightage in admission.
I declare that particulars furnished in this form are true to the best of my knowledge & belief.
DATE:
Signature of the Applicant
Principal
MAYURBHANJ LAW COLLEGE
BARIPADA
Your must bring with you the following document for verification.
Intimation Letter
The original marksheet of +3/equivalent examination/Degree Course in any discipline.
The original High School Certificate
The original College Leaving Certificate
The original Conduct Certificate from the Head of the Institution last attended.
The original and one attested photocopy of Caste Certificate. If applicable.
Original Income Certificate of the parent issued by the Revenue Officer not below the rank
of Addl. Tahasildar for S.C./S.T./O.B.C. students along with an attested photocopy
viii) The original certificate in support of claim, if any, for reservation/weight.
ix) Three (3) copies of recent stamp size photograph (attested)
x) Original Migration Certificate (if the student have passed from other than N.O. University)
i)
ii)
iii)
iv)
v)
vi)
vii)
(to be detached and
sent as Intimation
Letter)
PRINCIPAL
Mayurbhanj Law College
BARIPADA
DECLARATION & UNDERTAKING
I Sri/Kumari/Srimati ___________________________________________________________________________submit
myself to the jurisdiction of the authorities of Mayurbhanj Law College, Baripada for the session _______________ and
declare that shall abide by the rules and regulations. The decision of the authority for admission for the session
_____________ about my merit position shall be binding and acceptable to me. I do herby declare that the particulars
stated in and attached to by me this application are true to the best of my knowledge. I have read the Prospectus and
have satisfied myself that I fulfill the admission eligibility criteria. In the event of my being found ineligible even at a later
state. I undertake to forfeit my claim for admission, and if already selected/ admitted, my selection/admission shall be
cancelled. If admitted I undertake to attend all classes regularly and I will abide the rules and regulations of the College
authorities from time to time.
Further undertake that I shall not resort to ragging or any other acts of misbehaviour to the students of the
College on or outside the college premises, during the period my studentship. In case it is found that I am involved in such
ragging activities, my name shall be struck off from the institution and I will submit myself for any Legal action deemed fit
by the authorities concerned.
Signature of Mother/Father/Guardian
Signature of the Applicant
Date : --------------------
Date : -------------------
INTIMATION LETTER
[PROVISIONAL]
To
(the applicant is to write his full name here)
st
You have been selected for admission into 1 SEMESTER (3 years L.L.B. Course) of
the College.
You should get yourself admitted on --------------------------------During the college hour between ------------- a.m/p.m. to -------- p.m. failing which you will
forfit your seat. No extension of time will be allowed.
Principal
Mayurbhanj Law College, Baripada
(to be detached and
sent as
Intimation Letter)