1

ADMISSION FORM

APPLICATION NO. (FOR OFFICE USE ONLY)

2 0 1 4 0 1 __ __ __ __

UNIVERSITY

STREAM

COURSE

COURSE CODE

SESSION

Name of Candidate

Gender

Date of Birth

T H D A Y O F

Marital Status

Employment Status

Name of the Organization, if Working

Father Name

Maiden Name

Paste

Passport Size

photograph.

Do not staple.

2

Address

Contact Number

E-mail Address

Education Details

Examination Level Board /University Marks/Grade Year of

Passing

Medium

X Class

XII Class

Graduation

Fee Structure

Due Dates Mode of Payment Amount Balance

Check List

Ф Application form completely filled and signed

Ф 4 Passport size photographs

Ф Photo Identity

Ф Photocopy of Graduation Certificate

Ф Photocopy of Standard XII/X mark sheet and certificates

Ф Name Change Document

Certificate of Understanding

Ф I declare that the information provided by me in the application form is true and correct to the

best of my knowledge. I am fully aware that in case any information provided is found false or

erroneous; it will result in cancellation of my registration/admission. I am aware of all the rules

especially related to

o Provisional Admission

o Payment of program fee, exam fee and other fee

o Program fee installment option and mode of payment

o Cancellation of admission

o Rules for refund of program fee

o Rules related to forfeiture of

o Jurisdiction

Ф I also agree to abide by all the rules and policies of the institute.

Ф I understand that CGPSR is working as an education consultant and not an admission center for

any university.

Ф I have authorized CGPSR to apply in ___________________________ university on my behalf

for which they are charging their consultancy fees. And this will not amounts to sale of

prospectus / admission form to me. In addition, I have no objection on the amount so charges

as consultancy fee.

Place: ___________________ __________________________

(Signature of Candidate)

Date: ___________________