Name Of Applicant *(आवेदक का नाम)

Mother's Name *(माता का नाम)

Father's Name *(पिता का नाम)

Date of Birth *(जन्म तिथि)

Gender *(लिंग)
Male Female

Religion *(धर्म)

Category *(श्रेणी)

Sub Category *(ऊप श्रेणी)

E-mail ID

Mobile No Of applicant *(कृपया 10 अंको का मोबाइल न. भरे)

Aadhar No. *(कृपया 12 अंको का आधार न. भरे)

Horizontal
Physically Handicap(दिव्यांग)
Dependent of Freedom Fighter(स्वतंत्रता सेनानी पाल्य)
Defence Personel(प्रतिरक्षा कर्मचारी)

Weightage
N.C.C (B Certificate)
N.C.C (C Certificate)
N.S.S (240 Hours Certificate)
College Employee Dependent (पाल्य)
Rajyapal Award (राज्यपाल पुरस्कार)
Scout and Guide (तृतीय सोपान)
Ranger, Nipun Exam Passed
Ranger, Member of National Team

Nationality *( राष्ट्रीयता )

If Permanent Residence of Uttar Pradesh*(यदि आप उत्तर प्रदेश के मूल निवासी है)
Yes No

If Belongs To Minority*(क्या आप अल्पसंख्यक है?)

If Yes *(यदि हाँ)

Correspondence Address *(पत्राचार हेतु पता फोन नंबर सहित)

Permanent Address *(स्थायी पता फोन नंबर सहित) Same as Correspondence Address

Local guardian name * Local guardian contact no.

Local guardian address *

Father's/Guardian's Annual Income *(पिता की वार्षिक आय)

Income Certificate No. (आय प्रमाण पत्र यदि लागू हो)

Bank Name *(बैंक का नाम)

Branch *(शाखा)

Account No *(खाता संख्या)

IFSC Code *

1. Details of High school *

Year *

Name of board *

School/College Name *

Roll no. *

Max Marks *

Marks Obtained *

Percentage *

Subject *

2. Details of Intermediate examination *

Year *

Name of board *

School/College Name *

Roll no. *

Max Marks *

Marks Obtained *

Percentage *

Subject *

3. Details of Previous Year *

Year *

Name of University *

Roll no. *

SGPA

YGPA

Subject *

Result Status

Result Awaited Passed

Subject Selection:-

1. Compulsory Subject*

Physics Math Chemistry

6. Environment Science

Cleared Not Cleared

Enrollment Number

क्या आपके विरुद्ध कोई अभियोग चल रहा है , चल चुका है किसी अभियोग में दण्डित हो चुके हैं यदि हाँ तो पूर्ण विवरण दें -

Description

क्या आप गत परीक्षाओं में अनुचित साधन का प्रयोग करते पकड़े गए हैं यदि हाँ तो पूर्ण विवरण दें ।

Description

क्या विगत सत्र आपको महाविद्यालय प्रशासन ने अनुशासन भंग करने के कारण चेतावनी दी / निलंबित किया / निष्काषित किया ? यदि हाँ तो पूर्ण विवरण दें गलत जानकारी के लिए प्रवेश पर विचार नहीं किया जाएगा/प्रवेश निरस्त कर दिया जायेगा ।

Description

क्या आप सेवारत हैं यदि हाँ, तो अपने पद, कार्यालय और नियोजन का उल्लेख करें।

Description

क्या आपने वर्तमान सत्र में किसी अन्य शिक्षण सस्थान में प्रवेश लिया है यदि हाँ तो उल्लेख करें ।

Description

Upload Your Signature

Your Form Submited Sucessfully.Forms without Admission No. will not be accepted.

Take Printout Your Admission Form, S.R. Form and Chalan.

Government Post Graduate College, Sambhal, U.P.

Admission For the Course of

Admission No.	:
Registration Date	:
Student's Name	:
Mother's Name	:
Father's Name	:
Gender	:
Aadhar No.	:
Date of Birth	:
Category	:
SubCategory	:
Religion	:
Nationality	:
Domicile	:
Enrollment Number	:
Bank Name	:
Branch Name	:
Account Number	:
IFSC Code	:

Current Address	Permanent Address

Weightage	Horizontal

Mobile:-	Guardian Name:-
E-mail ID:-	Guardian Mobile Number:-
Amount:-	Local Guardian Address:-

Exam Name	Year	Roll No.	Board/ University	Subjects	Obtained Marks	Max Marks	Percentage
High School
Intermediate

Exam Name	Year	Roll No.	Marks Obtain	Max Mark	Percentage	Subjects	Status
B.Sc. I

Sl.N.	Subjects

1.	Is there any prosecution going on against you, has been convicted in any suit, give full details.
2.	Are you caught using unfair means in past exams, give full details.
3.	Did the past session warn you / suspended / expelled due to dissolution of the past session? If yes, then complete details. Admission will be terminated providing wrong information.
4.	If you are serving, mention your post, office and employment.

Declaration by the Candidate

I hereby solemnly affirm that the above statement is true to the best of my knowledge and belief and no part of the same is false and I further affirm that as a student I have read and understood the prospectus of the Govt. Post Graduate College, Sambhal and shall abide by all rules and regulations and code of conduct of the college. I further declare that if anything found or disclosed false in the above statement, the college administration is free to take any disciplinary action against me.

Admission Date	Sign of Father/Guardian	Signature of Candidate

Signature of Principal	Signature of Convenor	Admission Cell

Original documents required at the time of admission :

10th Mark sheet and certificate. (हाई स्कूल अंक पत्र एवं प्रमाण पत्र)
12th Mark sheet and certificate. (इंटरमीडिएट अंक पत्र एवं प्रमाण पत्र)
Residence certificate (निवास प्रमाण पत्र) / Adhar card (आधार कार्ड)
Caste certificate with verfication(If applicable) (जाति प्रमाण पत्र वेरिफिकेशन के साथ), यदि लागू हो .
Income certificate with verfication (If applicable) (आय प्रमाण पत्र वेरिफिकेशन के साथ), यदि लागू हो
Transfer Certificate {T.C.} (Photo copy only) (टी0 सी0, छाया प्रति)
Character certificate {C.C.} (Photo copy only) (सी0 सी0, छाया प्रति)
Copy of Bank pass book (बैंक पास बुक की प्रति)
02 Passport size new photographs (02नवीनतम पासपोर्ट फोटो)
Bank Chalan print out (बैंक चालान का प्रिंट आउट)

Acknowledgement

Admission Form bearing admission no. received from Miss/Mrs. Son/Daughter of Class

Date: ..................	Admission Cell

Government Post Graduate College, U.P.

S.R. FORM

Session 2022 - 23

Admission No. :-

Student's Name :-

Father's Name :-

Gender :-

D.O.B :-

Name of the last Institute :-

Permanent Address :-

Phone/Mobile Number :-

Signature of Gaurdian

Date

District Co-operative Bank Ltd.

Hayat Nagar, Sambhal

Admission No.:-	Bank Copy

A/C No.:- S/B - 2178

Govt. Degree College, Sambhal

Denominations
2000 X
500 X
100 X
50 X
20 X
10 X
5 X
2 X
1 X
Total

Total Amount:-

Admission Cell	Cashier

Student's Name:-
Father's Name:-
Category:-
Class:-,

Date:-	Student Signature

District Co-operative Bank Ltd.

Hayat Nagar, Sambhal

Admission No.:-	College Copy

A/C No.:- S/B - 2178

Govt. Degree College, Sambhal

Denominations
2000 X
500 X
100 X
50 X
20 X
10 X
5 X
2 X
1 X
Total

Total Amount:-

Admission Cell	Cashier

Student's Name:-
Father's Name:-
Category:-
Class:-,

Date:-	Student Signature

District Co-operative Bank Ltd.

Hayat Nagar, Sambhal

Admission No.:-	Student Copy

A/C No.:- S/B - 2178

Govt. Degree College, Sambhal

Denominations
2000 X
500 X
100 X
50 X
20 X
10 X
5 X
2 X
1 X
Total

Total Amount:-

Admission Cell	Cashier

Student's Name:-
Father's Name:-
Category:-
Class:-,

Date:-	Student Signature

Government Degree College, Sambhal- 244303 (Uttarpradesh)

राजकीय महाविद्यालय, सम्भल- 244303 (उत्तर -प्रदेश)

Registration Form

Bank Detail (बैंक खाता विवरण) :

Education Detail :

Your Form Submited Sucessfully.Forms without Admission No. will not be accepted.

Government Post Graduate College, Sambhal, U.P.

Admission For the Course of

Acknowledgement

Government Post Graduate College, U.P.

S.R. FORM

Session 2022 - 23

Admission No. :-

Student's Name :-

Father's Name :-

Gender :-

D.O.B :-

Name of the last Institute :-

Permanent Address :-

Phone/Mobile Number :-

Signature of Gaurdian

Date