Price: Rs.

1000/-

Baba Farid University of Health Sciences

Sadiq Road, Faridkot 151203 (Pb) INDIA
For Office use only:
Received Rs./US$_________

Application for obtaining

Equivalence/Eligibility Certificate

Receipt No. _____________

(For admission Ophthalmic Techniques, Medical Radiography & Imaging Technology,

Radiotherapy, Orthopedic Assistant & Plaster Techniques, Operation Theatre Technology, Dialysis
Technician, Anesthesia Technology, Emergency Responder, Intensive Care Unit Technology
,Bachelor of Audiology & Speech Language Pathology courses under NRI quota only)
Session 2015-16
(A)

(i)

Name Mr./Miss/Mrs.________________________________________________
(In capital letters)

(ii)

Father's Name
(In capital letters)

________________________________________________

(iii)

Mother's Name
(In capital letters)

________________________________________________

(iv)

Date of Birth

________________________________________________

(v)

Admission being sought for :

(a) Course ______________________
(b) Year/Session___________________

(vi)
(B)

Country____________ Passport No. _______________

Full Address:_____________________________________________________________
(Abroad)
______________________________________________________________
______________________________________________________________
______________________________________________________________
Telephone No__________________Fax Number_________________________________
e-mail address: ___________________________________________________________

(C)

Full Address ______________________________________________________________

(India)
______________________________________________________________
______________________________________________________________
Telephone No.____________________Fax Number_______________________________
e-mail address: _____________________________________________________________

(D)

1. Examination passed _________________________(10+1/equivalent) in the year ___________ under

Roll No. _______________ from the University/Board/Institution ____________________________.
P.T.O.

2. Examination passed_______________________ (10+2/equivalent) in the year_____________under

Roll No._______________from the University/Board/Institution___________________________.
_________________________________________________________as detailed below:Subjects

Marks/Grade
Obtained
10+1

10+2

Maximum
Marks
10+1

10+2

English
Physics
Chemistry
Biology

2.
3.
4.
(E)

Total(PCB)
Total(PCBE)
Name of the School/College _________________________________________________
Whether the institution is recognized?
Yes/No
(Please attach certificate if yes)
Whether University/ Board is recognized?
Yes/No
(Please attach proof)
Particulars of fee remitted
(i)
Amount_______________Bank Draft No__________________ Dated________________
Drawn on ____________________________Bank; payable at____________(In India).
(ii)
University Receipt No._____________Dated______________

Dated________________
Enclosures:
1 10+2/ equivalent examination detailed marks certificate(s)

Signature of the Applicant

5

Character/Recommendation Certificate from the Head

of the Institution last attended.

6
7
8

10+1 DMC.
NRI Proof of the candidate/Parents
Certificate of passing qualifying exam as a regular candidate from a recognized
institution

(The certificate(s) must show the marks of

Physics, Chemistry, Biology & English)
2
3
4

Explanation Sheet of grades

Date of Birth Certificate.
10+2 or equivalent examination Certificate

Note:- These documents should be original along with Photocopies duly attested by a competent authority.

______________________________________________________________________________

(For Office Use Only)

Qualifying examination passed, which is equivalent to 10+2 examination of PSEB/CBSE/ICSE, as a
student of _________________________ Institution/School/College, which is recognized and from
____________________________________Board/University. This Board/University is recognized
one.
(ii)
The candidate has passed in such qualifying examination from a recognized institution in the subjects of
Physics, Chemistry, Biology and English individually and obtained 40% marks B.Sc courses in
Physics, Chemistry & Biology (PCB) taken together.
(ii)
Eligible for admission
to___________________________________________________________________
_______________________________________________________________________________________
(iii)
Not eligible for admission since he/she________________________________________________________
_______________________________________________________________________________________
(i)

DEO
Supdt.II
Supdt.
Joint Registrar