391671
Session
Application No.
Specimen Signature of the Candidate (Inside the Box)
ENROLLMENT NUMBER
(For Office Use Only)
0
PROGRAMME APPLIED FOR BACHELOR OF ARTS - HINDI,POLITICAL
(Including Subject/Specialization) SCIENCE,SOCIOLOGY (FRESH_ADMISSION 1 Year)
1. Name in CAPITAL LETTERS (In English)
DEEPAK CHODHARY
2. Father's Name : {all the Candidates Including married women will mention Name of Father}
SATVEER SINGH
3. Mother's Name :
SARITA DEVI
4. Sex: (v Tick) Male Female 5. Date of Birth : Date Month Year
12 08 1996
6. Address for Correspondence (do not repeat name)
H NO-0 GALI NO-5, BRAMPURI MODINAGAR, GHAZIABAD, UTTAR PRADESH - 201204
UTTAR PRADESH
Pin Code 2 0 1 2 0 4
Phone No. with STD Code Mobile No. E-mail
7017462878 jaatd36@[Link]
Please check that you have enclosedthe DD for the prescribed fees in full and other certificates as
indicated in prospectus.
7. Details of Fee Payment : Demand Draft drawn in favour of SVSU, Distance Education, Payable at Meerut
Demand Draft No. Date
Bank Amount
Amount in Words
[Link] 9. Category ( tick mark whichever is applicable)
INDIAN (Please attach category certificate if applicable)
10. Employment Status Gen. OBC SC ST Others
EMPLOYED
Name of Year of Name of University/Board
Examination Subject Passing Division/Grade
HINDI 2012 UP BOARD
ENGLISH
MATHEMATICS
10th SCIENCE I
SOCIAL
SCIENCE
DRAWING
GEN HINDI 2014 UP BOARD
ENGLISH
BOOK
KEEP&ACCT
12th BUSI I
ORG&CRPND
BANKING
SPORT & PHY
EDU
UG
PG
OTH
DECLARATION
I hereby declare that the information furnished herein above is true and correct to the best of my knowledge
and belief. I further declare that the attested photocopies of the certificates submitted by me at the time of
admission are the true copies of the originals. I have read the prospectus and the rules and regulations of the
University. In Case any information is found incorrect, at any stage, I agree to forego the fee deposited and
also the claim for admission.
Place & Date : Signature of the Applicant
Eligible: Yes No Course Fee paid in Full Yes No
For Receipt Issued Yes No Original Verified Yes No
Granted provissional admission subject to ratification by University.
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(To be filled by the Office)
Recommedation of Checking Officer ________________________________________
This is to Certify that the candidate is eligible for admission . Enrollment No. may be allotted.
Enrollment No ................................................... ..................................................
Checked By ...................................................... Signature
Date : ....................................................... (Sanctioning Authority)