Form #

Category General

PRN 14010125102

SET ID 501674

FOR OFFICE USE ONLY

Challan #

DD (as per Cheque No.)

Date

Bank Name

Amount

BK1D0000503

15 July, 2015

Indian Bank

241000

Verified by (Office Assistant): _________________

IMPORTANT INSTRUCTIONS
The rules framed under the authority of S.I.U are applicable to the existing students of S.I.U. and those
who are eligible to continue their admission in the subsequent semesters.

Following rules are applicable for the purpose of seeking admission to a particular semester programme:

A student of I year (Sem I & II ) will be admitted to the 2nd year (Sem III & IV) irrespective of the number
of courses in which he/she has failed at the 1st year (Sem I & II) examination.
A Student will attend classes of all years with his/her batch. However he/she:
Cannot appear for end Semester 5 exams if he/she has not cleared upto Semester 1.
Cannot appear for end Semester 6 exams if he/she has not cleared upto Semester 2.
Cannot appear for end Semester 7 exams if he/she has not cleared upto Semester 3.
Cannot appear for end Semester 8 exams if he/she has not cleared upto Semester 4.
Cannot appear for end Semester 9 exams if he/she has not cleared upto Semester 5.
Cannot appear for end Semester 10 exams if he/she has not cleared upto Semester 6.

Note: For the calculations of backlogs, both Internal and External Examinations Marks will be considered.
(The application form with signature of individual student & parent will be submitted to SLS Pune office .)

Page 1 of 9

To,
The Director
Symbiosis Law School, Pune
Senapati Bapat Road, Pune - 411004
I wish to apply for admission to the _______ year Law Programme of BA LLB for the Academic Year 20152016.

Page 2 of 9

PERSONAL INFORMATION

Name

Adhiraj Singh Chauhan

Mobile No.

8550998778

Phone No.

02025817894

Email ID

chauhan.adhiraj@yahoo.com

Date of Birth

24 October, 1996

Place of Birth

SIKAR

Gender

Male

Religion

Hindu

Caste/Sub-Caste

RAJPUT

Nationality:

INDIAN

Blood Group

O+

PERMANENT ADDRESS

Address

16, Field Marshal Cariappa Marg, Kirkee, Pune

City/District

Pune

PIN Code

411003

State

Maharashtra

Country

India

CORRESPONDENCE ADDRESS

Address

16, Field Marshal Cariappa Marg, Kirkee, Pune

City/District

Pune

PIN Code

411003

State

Maharashtra

Country

India

Page 3 of 9

MOTHER'S INFORMATION

First Name

Tanuja

Middle Name
Last Name

Chauhan

Relation

Mother

Occupation
Yearly Income
Mobile No.

+ 91 8308840444

Phone No.
Email Address

kjschauhan1025@gmail.com

FATHER'S INFORMATION

First Name

Kamaljeet

Middle Name

Singh

Last Name

Chauhan

Relation

Father

Occupation

Government Officer

Yearly Income

1245820

Mobile No.

+ 91 8550998776

Phone No.

02025810661

Email Address

kjschauhan1025@gmail.com

ACADEMIC QUALIFICATIONS

Examinations Month &

University
Passed
Year

College

Total
Marks in
%

Class /
Grade

Regular /
External /
Correspondence

81.7

A2

Regular

Mar-12

CBSE

St. Aloysius
Sr.Sec.School,
Jabalpur

XI

Mar-13

CBSE

St. Aloysius
Sr.Sec.School,
Jabalpur

67.3

B2

Regular

XII

MAR-14

CBSE

Army Public
School,
Kirkee, Pune

89.8

A2

Regular

Page 4 of 9

DOCUMENTS ENCLOSED:

Caste Certificate - 2 copies

N/A

Please note that till the time all documents are deposited at the office and your eligibility is confirmed by
Symbiosis International University, Pune (SIU), the admission shall remain provisional.

Page 5 of 9

UNDERTAKING BY THE STUDENT

1. I hereby submit to the disciplinary jurisdiction of the Director, SLS Pune & SIU and I shall observe and
abide by the rules made by the SIU and SLS Pune.
2. I have carefully noted the rules and procedure of the admission as given in the prospectus which I am
required to follow and shall in matters of interpretation accept the decision given by the Director, SLS
in this respect as final and binding.
3. I am aware that the CGPA (Cumulative Grade Point Average) system of examination/
evaluation shall be applicable to me.
4. I shall comply with the school decision on all academic matters.
5. I am aware of the refund rules for fees as mentioned in the prospectus.
6. I understand that the BBALL.B/ BA.LLB. is a five years integrated course and I will be awarded the BBA.
LL.B/ BA.LL.B (as I have opted for) degree at the end of the 5th academic year on my successful
completion of 5 years.
7. I, also undertake to abide by the rules framed as regards the school uniform.
8. I have read through the code of Conduct and hereby agree to abide by the rules and regulations given
therein.
9. I am aware about the Anti Ragging rules & regulations of the school & the punishment liable if found
guilty of ragging, which is clearly mentioned in code of conduct also.
10. If I fail to comply with the above and all other rules and regulations of the school, my admission is
liable to be cancelled without giving any notice.
11. All disputes will be subject to Arbitration within Pune Jurisdiction.
All admissions are strictly provisional till the final approval by the University.

Signature of Applicant

Signature of Parent/Guardian

UNDERTAKING BY STUDENTS ON TNG

1. I hereby undertake to put in maximum attendance to all classes.
2. I am aware that I can claim exemption (including all grounds such as medical, family emergency,
cultural events, Symbhav, other co-curricular & extra-curricular activities) for maximum of 15
(fifteen) working days or equivalent number of lectures in the given semester.
3. I am also aware that any default in this regard or falling below 75% attendance will result in TNG (Term
Not Granted).
4. Any TNG during the student life cycle of 5 years will disentitle me to all privileges such as participating
in inter-collegiate events like Moots, Seminars, Debates and Screening for campus placement.

Signature of Student

I hereby undertake that my ward shall comply with the above and I shall co-operate with the institute in
case of TNG.

Countersigned by Parents

Page 6 of 9

MEDICAL UNDERTAKING BY STUDENTS

1. I Adhiraj Singh Chauhan student of BA LLB am aware that and I am entitled to Medical Insurance Cover
for authorized Medical Expenditures only as per Symbiosis Society Rules, in case of Sickness/Accident
and admission to Hospital.
2. I undertake that I will inform the College and SCHC authorities about any sickness/accident within 48
hours by Telephone/Email or through Parents/any authorized person in writing.
3. In case of absence due to Medical Reasons for Three Days I can take treatment from Private Medical
Practitioner and submit Certificate to this effect. In case of sickness of more than Three Days Medical
Documents along with the Medical Certificate will be submitted to SCHC for processing of Medical Leave
immediately on joining the Law School.
4. I am aware that Medical Leave is part of absence within permissible 25% & no special concession will be
given for absence on Medical grounds for TNG.
5. The Director Symbiosis Law School, Pune reserves the Right of considering Medical absence of critical
cases on production of Medical Documents.
6. I undertake to comply with the aforesaid instruction and in case of any Violation or Non compliance of
rules, action as deemed necessary will be initiated against me.

Signature of Student

DECISION BY THE DIRECTOR (FOR OFFICE USE ONLY)

Admitted to class _______________ Div _______________ Roll No./PRN No. ______________________
Provisionally, till the final approval by the Symbiosis International University.

Administrative Office

Director

Page 7 of 9

DECLARATION BY THE STUDENT

1. I, Adhiraj Singh Chauhan (full name of student with admission/registration/enrollment number), S/o D/o
Mr./Mrs. of Kamaljeet Singh Chauhan having been admitted to Symbiosis Law School, Pune have known
the UGC Regulations on Curbing the Menace of Ragging in Higher Educational Institutions, 2009 and
fully understood the provisions contained in the said Regulations.
2. I have, in particular, perused clause 3 of the Regulations and am aware as to what constitutes ragging.
3. I have also, in particular, perused clause 7 and clause 9.1 of the Regulations and am fully aware of the
penal and administrative actions that is liable to be taken against me in case I am found guilty of or
abetting ragging, actively or passively, or being part of a conspiracy to promote ragging.
4. I hereby solemnly aware and under take that:
I will not indulge in any behavior or act that may be constituted as Ragging under clause 3 of the UGC
Regulations, 2009.
I will not participate in or abet or propagate through any act of commission or omission that may be
constituted as Ragging under clause 3 of the UGC Regulations.
5. I hereby affirm that, if found guilty of ragging, I am liable for punishment, without prejudice to any other
criminal action that may be taken against me under any penal law or any law for the time being in
force.

Date: 21 July, 2015

Signature of Student

DECLARATION BY THE PARENT / GUARDIAN

1. I, Kamaljeet Singh Chauhan, Father of Adhiraj Singh Chauhan (full name of the student with admission/
registration/enrollment number) having been admitted to Symbiosis Law School Pune is aware of UGC
Regulations on Curbing the Menace of Ragging in Higher Educational Institutions, 2009 and fully
understood the provisions contained in the said Regulations.
2. I have, in particular, perused clause 3 of the Regulations and am aware as to what constitutes ragging.
3. I have also, in particular, perused clause 7 and clause 9.1 of the Regulations and am fully aware of the
penal and administrative actions that is liable to be taken against me in case I am found guilty of or
abetting ragging, actively or passively, or being part of a conspiracy to promote ragging.
4. I hereby solemnly aware and under take that:
I will not indulge in any behavior or act that may be constituted as Ragging under clause 3 of the UGC
Regulations.
I will not participate in or abet or propagate through any act of commission or omission that may be
constituted as Ragging under clause 3 of the UGC Regulations.
5. I hereby affirm that, if found guilty of ragging, I am liable for punishment, without prejudice to any other
criminal action that may be taken against me under any penal law or any law for the time being in
force.

Date: 21 July, 2015

Signature of Parent/Guardian

Page 8 of 9

Fees Challan

Name of the Student Adhiraj Singh

Chauhan

Programme BA LLB

Year

Division

PRN No. 14010125102

Paid to Symbiosis Law School, Pune

Challan #

DD (as per Cheque No.)

Date

Bank Name

Amount

BK1D0000503

15 July, 2015

Indian Bank

241000

Total Rs. (in words): ____________________________________________

Checked by: ____________________________________________

Name of the Student Adhiraj Singh

Chauhan

Programme BA LLB

Year

Division

PRN No. 14010125102

Paid to Symbiosis Law School, Pune

Challan #

DD (as per Cheque No.)

Date

Bank Name

Amount

BK1D0000503

15 July, 2015

Indian Bank

241000

Total Rs. (in words): ____________________________________________

Checked by: ____________________________________________

Name of the Student Adhiraj Singh

Chauhan

Programme BA LLB

Year

Division

PRN No. 14010125102

Paid to Symbiosis Law School, Pune

Challan #

DD (as per Cheque No.)

Date

Bank Name

Amount

BK1D0000503

15 July, 2015

Indian Bank

241000

Total Rs. (in words): ____________________________________________

Checked by: ____________________________________________

Page 9 of 9