Application Form

Application_No:-40

APPLICATION FOR ADMISSION TO I PUC - ACADEMIC YEAR 2020 TO 2021

ARTS / SCIENCE / COMMERCE

INSTRUCTIONS :

1. Admission to PUC is provisional & is subjected to Department approval.
2. Please submit the following at the time of admission :

a) Xerox copy of the 10th Std. Marks Card. (No orginal Marks Card will be collected) b) Original T.C with Xerox copy c) Xerox copy of caste and income certificate (Acknowledgements are not accepted.) e) Recent photographs : (Photos in School Uniform are not accepted) ) Passport size - 3 (colour) ) Stamp size - 2 (colour) f) Copy of BPL Ration Card (only for BPL Card holders) g) Student Bank Pass Book copy 3. TC will not be returned, once it is submitted.
4.Submit the application form in college office within three days of result. Pay the application money of Rs.50 at the time of submission.
Note : Xerox copy of Adhar Card & 10th Std. Hall Ticket is compulsory at the time of submission of the application

Student Profile

Applicant Photo : *(Photo with School Uniform is not accepted)

Name of the applicant(in block letters) *as per the SSLC or its equivalent certificates

Date of birth *

- -

Place of Birth: *

State: *

Religion: *

Caste / Sub caste: *

Monther Tongue: *

Blood Group *

✓ Tick appropriate box R.C.:

General merit:	Scheduled Caste:	Scheduled tribe:
Group1:	Group 2a:	Group 2b:
Group 3a:	Group 3b:	Handicapped:

Candidate's Address

Residential Address of the student(Permanent): *

Correspondence Address: * If Permanent address same as correspondence address tick this

Nationality : *

Aadhar No. of the candidate: *

Father's Details

Father's Name: *As per SSLC marks card in block letter

Occupation: *

Annual Income: *

Mobile No: *

Mother's Details

Mother's Name: *As per SSLC marks card in block letter

Occupation: *

Mobile No: *

Local Gurdian's Details

Local Guardian's Name: (optional)

Address: (optional)

Mobile No: (optional)

Previous School / College details

Name and address of the School/College last studied *

Medium: *

Dist: *

State: *

Details of SSLC or equivalent examination passed:

Details	Subject	Maximum Marks
Name of the Examination passed: Reg. Number: Month & year of passing -		125/100
		100
		100
		100
		100
		100
	TOTAL:	625/600

CHOICE OF STREAM :
CHOICE OF STREAM *	COMMERCE (HEBA) : History, Economics, Business Studies & Accountancy (HECA) COMMERCE (EBAB) : Economics, Business Studies Accountancy & Basic Maths (MECA) COMMERCE (EBAS) : Economics, Business Studies, Accountancy & Statistics COMMERCE (BASC) : Business Studies, Accountancy, Statistics & Computer Science SCIENCE GROUP (PCMB) : Physics, Chemistry, Maths & Biology SCIENCE GROUP (PCMC) : Physics, Chemistry, Maths & Computer Science ARTS STREAM(HEPS)History, Economics, Sociology & Political Science
Part 1 - languages (1) *	English
(2) *	Kannada Hindi French

STUDENTS' AND PARENTS/GUARDIAN'S UNDERTAKING

1.The above furnished details are true to my knowledge.
2.I will abide by the rules of the PU board and college in all aspects during my study.
3.I will maintain discipline and pay for damages caused to the assets of the college either by me or as a group.
4.No Original Certificates are submitted to the college except the original T.C. of the 10th std.