BHARATI VIDYAPEETH UNIVERSITY, PUNE

CET-2013
For Admission to

FORM NO

38969
EXAM CODE

B. Tech 2013
Read Instructions given at the end of the second page carefully. Candidate Name : ANJALI RAI

18

Gender: Female

Date of Birth: 22-Oct-1995

Category: OPEN

Address of Communication:

Affix Passport size Photograph here, Do not stapple or Pin the Photograph

*****+,KUMAR PICTURE PALACE,BAHRAICH

BAHRAICH,UTTAR PRADESH,271801
Phone No: 0 E-Mail : shalinitripathi.2009@gmail.com Mobile: **********

YEAR OF PASSING WITH MARKS DETAILS HSC GROUP DETAILS HSC DETAILS SSC DETAILS

Sign Candidate Signature

SSC YEAR

2012
391

HSC YEAR

2012 320
Obtained :
Out Of :

SSC MARKS :

HSC MARKS :
HSC OUT OF:

320 500

SSC OUT OF :

500

500

NAME & ADDRESS OF PARENT/GUARDIAN Parent Name: SUSHIL KUMAR RAI

CHOICE OF CENTER

Address:

Lucknow
*****+,KUMAR PICTURE PALACE,BAHRAICH
BAHRAICH,UTTAR PRADESH,271801

Phone No:

Mobile:

E-Mail

LAST SCHOOL/COLLEGE DETAILS

SCHOOL/COLLEGE:

TARA MAHILA INTER COLLEGE BAHRAICH

ADDRESS:

NAGAR PALIKA PARISHAD BAHRAICH

PHONE NO:

SUBJECT OFFERED IN HSC/12 TH

Instruction:

If any information is not Printed on form please write with black pen.

Declaration - I A. I hereby declare that the information fill online in this form is true and Complete to the best of my knowledge. I am aware that if any information herein is found to be incorrect or incomplete, my application form will be rejected / admission will be cancelled. B. I have studied and understood the Rules Of Admission Procedure, and Fee Structure and agree to abide by these rules. C. I have read and understood all the provisions contained in the Prospectus and hereby agree to abide by these provisions. D. I am aware that any legal matters arising out of the total admission process through All India Common Entrance Test of Bharati Vidyapeeth University, 10 be to courts of Pune jurisdiction Pune 30 i.e.CET20 will be subject to will courts ofsubject Pune jurisdisction Maharashtra. Maharashtra.
P

Date:

Signature of the Candidate Name of the Candidate: ANJALI RAI

2. Declaration II A. I, the parent / guardian of (applicant) hereby declare that I am aware of the financial obligations of admitting my child / ward to the colleges of Bharati Vidyapeeth University. I agree to pay the Tuition fee and Other Fees to the Institution as fixed from time to time as per the rules. I also endorse the declaration made above by my child/ward. I have read all the rules governing the process of Common Entrance Test, Counseling, Admission and Fee Structure .of CET 2010 and agree to abide by the rules.

Place: Date: Signature of the Parent / Guardian Parent /Guardians Name: SUSHIL KUMAR RAI INSTRUCTIONS Machine readable form. Please do not staple. This form is of two pages. Please paste the photograph, Attest it(Attestation from head of the institute), Sign at any gadget officer appropriate places and bring along this form at the examination center

Bring Two Passport Size photographs at the time of exam Admit Card is to be sent by E-mail or Available at www.bharatividyapeethuniversity.net