CHAUDHARY CHARAN SINGH UNIVERSITY, MEERUT

Under-Graduate (UG) Admission Registration Form

SESSION 2017 - 2018
Registration # 17G0131068 Reg. Date : 6 July, 2017 04:11 PM

1. Candidate Name : SACHIN KUMAR

2. Father's Name : MOHAN LAL
3. Mother's Name : ANEETA DEVI
4. Date of Birth : 14-May-1998 5. Gender : MALE
6. Caste/Category : O.B.C. 7. Reservation : Not Applicable
8. Caste Certificate #: 9. Income Grp : Less than 1 Lac per
annum
10. Domicile : Uttar Pradesh 11. Religion : Hindu
12. Domicile Cert. #: 13. Is Minority : NO
14. Nationality : INDIAN 15. Other Cat. : Not Applicable

16. Address for Correspondance : 17. Permanent Address :

VILL....THONA POST KHANPUR
Bulandshahr
Uttar Pradesh
PIN Code : 202398

18. Mobile : 7830100665

20. Weightages Claimed :

A FT VILL....THONA POST KHANPUR
Bulandshahr
Uttar Pradesh
PIN Code : 202398

19. Email : satpaloo@gmail.com

Weightage Add %

21. Academic Record :

DR

Examination Year Max Obt. Stream Subjects Board %

Highschool 2014 600 351 N/a science U.P. Board of High School & Intermediate 58.5
Education, Allahabad.

Intermediate 2016 500 320 PCB GENERAL U.P. Board of High School & Intermediate 64
HINDI,ENGLISH,PHYS Education, Allahabad.
ICS,CHEMISTRY,BIOL
OGY,

22. College Application Details :

Sr. College Degree Subject/Group
1 [297] A.P. DEGREE COLLEGE UNCHAGAON , BULANDS B.A. Arts Group

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 CHAUDHARY CHARAN SINGH UNIVERSITY, MEERUT
Under-Graduate (UG) Admission Registration Form
SESSION 2017 - 2018
Registration # 17G0131068 Reg. Date : 6 July, 2017 04:11 PM

23. 10th Marksheet #: H09007026 24. 10th Roll No. : 0498786

25. 12th Marksheet #: 0 26. 12th Roll No. : 0419120

27. 10th Passing Year: 2014 28. 12th Passing Year :
29. AADHAAR No.: 813205572381 30. AADHAAR Enroll # :
31. Payment Details: Paid Rs.100.00 on 7/7/2017 PayU# 6265265156 Bank Ref: MAST - 9875467081871880
32. Other Qualifications :

A FT
NOTE: Mark the number of documents ( Photocopy/Xerox) attached by the Candidate during form submission to the college

Xth Marksheet Xth Certificate

XIIth Marksheet Last Exam Passed Marksheet
Recent Passport Sized Photograph Scanned Signature
DR

Domicile (for other state) Certificate for Kashmiri Resident

Certificate for Horz./Reservation Category Certificate for Vert./Caste Category

Declaration

I declare that I have never been convicted for any criminal act and that there is no case pending against me in
the court of law. I also declare that I have never been caught using Unfair Means or any Disciplinary action
has been taken against me. If I was charged for using Unfair Means, the punitive duration is over and charges
have been cleared.

I have read carefully and have understood all rules as mentioned in the University Rules and Admission
Brochure.

Furthermore I also declare that if my application is found to contain incorrect/false information regarding my
Name, Birth Date, Gender, Religion, Domicile, Weightage, Caste, Horizontal Reservation, Marks obtained or
any other field, my application is liable to get cancelled, and I will have no objection in getting disqualified for
admission to the concerned course/college.

Signature of Parent/Guardian Signature of Candidate

Date: Date:

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