Form No.
-------------
(izi=k la[;k)
APPLICATION FORM iratfy fo'ofo|ky;
vkosnu izi=k UNIVERSITY OF PATANJALI
Instructions (funsZ'k)
Please affix
l Please read the given instructions carefully, before filling the form. passport size
d`i;k iQkeZ Hkjus ls igys fn;s x;s funZs'kksa dks è;ku ls i<a+sA recent
l Fill the form in Capital letters with black ball pen. photograph
iQkeZ dSfiVy v{kjksa esa dkys ckWy iSu ls HkjsaA
Ñi;k uohu
l Do not staple the Photograph, paste it with gum. ikliks V Z
iQksVks dks LVSiy u djsa] bls xksan ls fpidk;saA vkdkj dk
l It is mandatory to fill all the information in the form. Nk;kfp=k fpidk,¡
iQkeZ esa lHkh lwpuk;sa Hkjuh vfuok;Z gaSA
l At the time of interview, the applicant should carry all the original documents.
lk{kkRdkj ds le; vH;FkhZ lHkh ewy izek.k&i=k vo'; ysdj vk;saA
1. Applied for the Programme/ Course: ikB~;Øe gsrq vkosnu
2. Name of the applicant as per Matriculation (in Capital letters )
3. gkbZ Ldwy izek.k&i=k ds vuqlkj vkosnd dk uke (fgUnh esa)
4. Father's Name (Capital letters in English)
5. firk dk uke (fgUnh esa)
6. Mother's Name (Capital letters in English).
7. ekrk dk uke (fgUnh esa)
8. Guardian's name in case of orphan (Capital letters in English).
9. vukFk gksus ij vfHkHkkod dk uke (fgUnh esa)
10. Date of Birth (as per High School Certificate) 11. Nationality (jk"Vªh;rk)
tUefrfFk (gkbZ Ldwy izek.k&i=k ds vuqlkj)
12. Birth Place (tUe LFkku) District (ftyk) State (jkT;)
13. Caste(tkfr) (enclose Certificate) (layXud izek.k&i=k)
14. Gender (fyax): Male (iq#"k) Female (efgyk) Transgender (leySfa xd)
15. Marital Status (oSokfgd Lrj) : Single (,dy) Married (fookfgr) Divorced (rykd'kqnk)
16. Spouse name if not divorced (ifr ;k ifRu dk uke ;fn rykd ugha gqvk gS)
(Signature Parent /Guardian) (Name and Signature of applicant)
(ekrk&firk@ vfHkHkkod ds gLrk{kj) (1) (vH;FkhZ dk uke ,oa gLrk{kj)
17. Whether Physically Challenged ('kkjhfjd fodykaxrk) : Yes (gk¡) (enclose certificate) (layXud izek.k&i=k) No (ugha)
18. Visible identification marks (n`';;h; igpku fpÉ):
19. Occupation of Father & Mother /Guardian/ Spouse (if married) :
ekrk vkSj firk@vfHkHkkod@ifr&iRuh (;fn fookfgr gSa) dk O;olk;
20. Parental Annual Income (iSf=kd okf"kZd vk;):
21. Participation: (attach copy of certificate if any) izfrHkkfxrk (izek.k&i=k dh izfrfyfi layXu djsa] ;fn gS)
(i) NSS (jk"Vªh; lsok ;kstuk): Yes (gk¡) No (ugha)
(ii) NCC (jk"Vªh; ØSfMV dksj) (B, C or G Part 1, 2 (ch] lh ;k th Hkkx 1] 2)) Yes (gk¡) No (ugha)
(iii) SPORT-(mention name): [ksy&uke (vafdr djsa)
22. Religion (/eZ): Hindu(fgUnw) Muslim (eqfLye) Sikh(fl[k) Christian(blkbZ) Others(vU;)
23. Aadhaar Number (vk/kj la[;k)
24. Correspondance Address (i=kkpkj irk)
Police Station (iqfyl LVs'ku) District (ftyk)
PINZIP Code (ihvkbZ,utsMvkbZih dksM) State (jkT;) Country (ns'k)
E-mail ID (bZ&esy vkbZMh)
25. Permanent Address (LFkk;h irk)
Police Station (iqfyl LVs'ku) District (ftyk)
PINZIP Code (ihvkbZ,utsMvkbZih dksM) State (jkT;) Country (ns'k)
E-mail ID (IN CAPITAL LETTERS) E-mail ID (bZ&esy vkbZMh&cMs+ v{kjksa es)a
26. Landline No. (?kjsyw nwjHkk"k ua-) Mobile No. (eksckbZy ua-)
27. Local Guardian name (if applicable) (LFkkuh; vfHkHkkod dk uke&;fn gks)
Address (irk)
Relation (lEcU/) Mobile No.(eksckbZy ua-)
E-mail (bZ&esy):
28. Last School/ College attended (vfUre Hkkxhnkjh fd;k x;k fo|ky;@egkfo|ky;)
District (ftyk) State (jkT;)
(Signature Parent /Guardian) (Name and Signature of applicant)
(ekrk&firk@ vfHkHkkod ds gLrk{kj) (2) (vH;FkhZ dk uke ,oa gLrk{kj)
29. Name of Board/ University of qualifying examination passed
cksMZ@fo'ofo|ky; dk uke tgk¡ ls ijh{kk mÙ[Link] dh gks
30. Detail of repeat/ supplementary Exam in qualifying Exam (if any) mÙ[Link] iquiZjh{kk@vuqiwjd ijh{kk dk fooj.k (;fn dksbZ gks)
31. Education Qualification (Enclose Attested Marks Sheets) 'kS{[Link] ;ksX;rk (layXud LogLrk{kfjr vadrkfydk)
Exam Passed Board/ School/ College/ Institution Year Subjects offered Marks Obtained Max. Marks %
University fo|ky;@egkfo|ky;@ laLFkku x`ghr fo"k; vf/dre vad izfr'kr
mÙ[Link] ijh{kk o"kZ iz k Irka d
cksMZ@fo'ofo|ky;
High School or Equivalent
gkbZ Ldwy vFkok led{k
Intermediate or Equivalent
[Link],V vFkok led{k
Graduation (If passed)
Lukrd
Graduation Appearing/
Appeared Up to V Semester/
2nd Year(for yearly exam
pattern)
Lukrd lfEefyÙkk@iape l=k
rd lfEefyÙkk@ f}rh; o"kZ&
(okf"kZd ijh{kk izk:i ds vuqlkj)
32. Gap Year if Any : Yes (gk¡) No (ugha) (Mention Gap Year/s if Yes)
(okf"kZd vUrjky] ;fn dksbZ gS) (;fn okf"kZd vUrjky gS] rks vafdr djsa)
33. Have you ever been punished for any in disciplinary activity Yes (gk¡) No (ugha)
(aD;k vkidks fdlh vuq'kklukRed xfrfof/ ds fy, [Link] fd;k x;k gS)
(Please furnish details if yes) (;fn gk¡ gS rks d`i;k fooj.k izLrqr djas)
34. Check list of the Certificates to be enclosed with the Application form: (vkosnu i=k ds lkFk layXu izek.k&i=kksa dh tka¡p lwph)
Sr. No. Self attested Copies No. of Copies
Ø-la- Lo gLrk{kfjr Nk;kizfr- Nk;kizfr dh la[;k
1- High School or Equivalent Examination Passing Marksheet.
(gkbZLdwy vFkok led{k ijh{kk vad i=k dh [Link] izfrfyfi)
2- High School or Equivalent Examination Passing Certificate.
(gkbZLdwy vFkok led{k ijh{kk izek.k&i=k dh [Link] izfrfyfi)
3- Intermediate (10+2) or Equivalent Examination Passing Marksheet.
(baVjehfM,V (10$2) vFkok led{k ijh{kk vad i=k dh [Link] izfrfyfi)
4- Graduation or Equivalent Examination Passing Marksheet.
(Lukrd vFkok led{k ijh{kk izek.k&i=k dh [Link] izfrfyfi)
4- Graduation or Equivalent Examination Passing Certificate.
(Lukrd vFkok led{k ijh{kk izek.k&i=k dh [Link] izfrfyfi)
5- Aadhaar Card.
(vk/kj dkMZ)
6- NSS/NCC/Sports Certificate (if any).
(jk"Vªh; lsok ;kstuk@jk"Vªh; dSfMV dksj@ [ksy izek.k&i=k)
7- Caste Certificate.
(tkfr izek.k&i=k)
(Signature Parent /Guardian) (Name and Signature of applicant)
(ekrk&firk@ vfHkHkkod ds gLrk{kj) (vH;FkhZ dk uke ,oa gLrk{kj)
(3)