College Roll No………………… Examination Roll No………...……………….
(To be assigned by the office)
-Autonomous College
Affiliated to Guru Nanak Dev University, Amritsar Affix
Examination Form Recent
(Tick ( ) for Full Subjects/Reappear/Improvement/Additional/Deficient Subjects)
(Candidates should not fill this form for improvement who got more than 60% marks)
Passport Size
Photograph
1. Registration No. …………………………………………………………………
2. Class ……………………….... Semester/Part ………..…….. Month……….. Year 20……..
3. Medium of Examination Tick ( ) English Punjabi Hindi
4. Academic record on the basis of which admission to this Examination is sought
Examination Board/University Month/Year Roll No. Pass/Reappear (if (Only for those Students who
Yes, specify here) have Passed Examination)
Total Marks Marks Obtained
5. Name (in English in Capital letters)
6. nwm (pMjwbI ivc)
7. Father’s Name (in English in Capital letters)
8. ipqw dw nwm (pMjwbI ivc)
9. Mother’s Name (in English in Capital letters)
10. mwqw dw nwm (pMjwbI ivc)
11. Date of Birth / / 12. Male/Female
13. Category Tick ( ) General SC BC ST Others (If Others, Specify ……………….)
14. Subjects/Papers in which to be examined
Sr. No. Name of Subject/Paper Opt (if any) Sr. No. Name of Subject/Paper Opt (if any)
1. 7.
2. 8.
3. 9.
4. 10.
5. 11.
6. 12.
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15. Are you simultaneously appearing in any paper of lower examinations? Yes No
If Yes, specify Semester(s)……………..
16. (a) Have you ever been disqualified or is there any case pending against you for unfair means by any other
University/College/Board? Yes No
(b) If yes, write the name of Examination……………………………..…… Year……………………………..
Roll No………… Duration of Disqualification ………….. Name of University/College/Board……………..
Only for Reappear/Improvement/Additional/Deficient Subjects/Special Chance Candidates:-
Office Cash Receipt No…………….………………….…. Date ………..…………… Amount………………….
Declaration by the Candidate
17. I hereby submit as under:
(i) I have gone through the syllabus and Rules for Eligibility for Final Examination (in Prospectus) and
understood the same for my eligibility for the Examination. In case of any discrepancy found in the
particulars filled in by me in this Form, I shall be responsible for the consequences.
(ii) I agree to the fact that all the disputes arising from the documents or information connected therewith
are subject to territorial jurisdiction of Courts situated at Amritsar only.
(iii) I understood if my result of this class is declared RESULT LATER—R.L. (FEE/Eli/REGD. No./D/
UMC etc. ) in the main Gazette by the College, the decision of the Chief Controller, Examinations will
be binding upon me.
(iv) Dates for theory examination have no relation with dates of declaration of Re-evaluation result.
(v) I have gone through the important information as laid down in this Examination Form.
Permanent Address Correspondence Address
………………………………………………………… …………………………………………………………
………………………………………………………… …………………………………………………………
………………………………………………………… …………………………………………………………
………………………………………………………… …………………………………………………………
E-mail: …………………………………………..……. …………………………………………………………
Tel. No/Mobile: ....…………………………………..... Tel. No/Mobile: ....…………………………………...
__________________________________
Date …….…………….. Signature of Candidate
For Office Use Only
The Candidate is eligible/not eligible to appear in the examination as per the information provided above by him
/her. If not eligible, Reason ..…………………………………………………………………………………………
Signature of Fee Clerk (Account Section) Signature of Clerk
Price: Rs. 200/-
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