PROVISIONAL ADMISSION FORM FOR GOVERNMENT AND PRIVATELY

MANAGED AIDED COLLEGES, CHANDIGARHSession : 2021-2022

Name of the Stream BSc Med Bioinformatics (Elective)- I Form No A44363

Applicant's Pool General Pool(Outside UT) Date of Apply 17/08/2021 20:39:11

Category Scheduled caste

Applicant's Details                                                                               (Gap - 1 Year) New Student | Hostel : No

Name SHREYA KAGRA

Date of Birth 12/10/2003

Gender Female

Nationality Indian

Religion Hindu

Mobile No(whatsapp) 7876609066

Email Address shreyakagra783@gmail.com

Annual Family Income Rs 7 - 8 Lakh / Yr

Voter/EPIC No. NA

Aadhar No NA

Account Number 1145001500011566

Name of the Bank PUNJAB NATIONAL BANK

IFSC Code PUNB0114500

Ration Card Holder No

Covid-19 Vaccination No First Dose :No Second Dose :No

Details of Father Details of Mother

Name NARINDER SINGH BABITA

Occupation teacher housewife

Mobile No 9418557745 7018725572

Office Address NA NA

Email Id NA NA

Details of Local Guardian Correspondence Address

Guardian's Name NA Address 1457/13 balmiki basti nahan

Occupation NA State Himachal Pradesh

Mobile No NA Pin Code 173001

Office Address NA Phone No 7876609066

Email Id NA

Academic Details

Exam Institute Board Roll No Passing Year Marks Obt./ MM Percentage

Matric DAV PUBLIC SCHOOL CBSE 2334526 2019 347 / 500 69.4%

10+2(Medical) CAREER ACADEMY SR SEC SCHOOL HP Board 2144044077 2021 451 / 500 90.2%

Any Scholarship at 10th/10+2 to Level NA

DECLARATION BY THE APPLICANTAPPLICANTS ARE REQUIRED TO COMPLETE AND ATTEST THE FOLLOWING DECLARATION AT THE TIME OF

SUBMISSION OF APPLICATION

1. I certify that the information and documents submitted in or with this application (all of which together constitute the application)

    are true, complete and correct. I understand that it is my responsibility to inform about any relevant changes in my information or

    application material, occurring between the date of submission of my application and display of provisional merit lists, and I agree

    to do so immediately after any such changes occur.

2. I certify that I have not been disqualified by any Board/University for misconduct or for any unfair means case:

    If disqualified, please specify the details given below:-

    (a) Year of Disqualification :-_______________________________________________________________

    (b) Name of the Board/University :-__________________________________________________________

    (c) Reason for disqualification:-_____________________________________________________________

3. I certify that no police case is pending against me anywhere in India/abroad:If police case is pending, then please specify the

    details given below:

    (a)No. of DDR/FIR: ____________________________________ Date & Year:- ______________________

    (b)Name of Thana/Police Station:- __________________________________________________________

    (c)Reason/Case:- _______________________________________________________________________

4. I certify that I am seeking admission at my own risk and responsibility.

5. I certify that I shall not take up any job during the college hours.

6. I certify that I have read and understood the rules and regulations, terms & conditions given in the prospectus.

7. I authorize the Department of Higher Education/Institution to verify the information provided by me.

Form No:- A44363

10+2(Medical) Subject wise Marks Details

ENGLISH PHYSICAL EDUCATION BIOLOGY CHEMISTRY PHYSICS Total

86 / 100 92 / 100 91 / 100 91 / 100 91 / 100 451 / 500

Weightage Percentage 90.20 Total 90.20

Have you applied for Re-evaluation ? No

SUBJECTS OFFERED

Compulsory Subjects History & Culture of Punjab , Bioinfomatics

Elective Subjects Zoology

List of Self attested Documents to be attached

Matriculation Certificate for Date Of Birth.Character Certificate(from the institution last attended or from a Gazetted

Officer in case of private applicants)(Specimen given in the Prospectus).

Migration Certificate . Scheduled caste

10+2 Certificate.

Form No:- A44363

8. I promise to submit my character certificate and migration certificate (if applicable) by uploading them latest by 30th September,

    2020. In case of default, I take full responsibility for any action taken against me by the college/ Panjab University, Chandigarh.

9. I promise to abide by all the college rules and regulations and shall not indulge in any subversive activity which, in the opinion of

    the college authorities, is detrimental to the interests of the college and its discipline.

10. I understand that on finding of any material/information which has been concealed, or that any given information which is false

    or misleading could invalidate my application and result in cancellation of admission and forfeiture of the entire fee paid.

11. I hereby state that the information given in this application is true and correct to the best of my knowledge and belief and

    nothing has been kept concealed in the form. In case any information given in this application proves to be false/ incorrect/

    concealed, besides cancellation of my admission, I shall also be responsible for the legal consequences vis. Prosecution under

    section 177 and 191 of the Indian Penal Code which stipulates imprisonment and fine.

Anti Ragging Declaration

       I, SHREYA KAGRA S/D/o Mr./Mrs./Ms NARINDER SINGH applying for admission to _________________ have read a copy

of the UGC Regulations on Curbing the Menace of Ragging in Higher Educational Institutions,2009, (herein after called the

'Regulations').

      1) I have carefully read and fully understood the provisions 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 action 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 aver and undertake that

           a) I will not indulge in any behaviour or act that may be constituted as ragging under clause 3 of the Regulations.

           b) 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 Regulations.

      5) I hereby affirm that, if found guilty of ragging, I am liable for punishment according to clause 9.1 of the Regulations, 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.

(to be signed at the time of admission)

All the Admitted students are required to submit online the Anti-Ragging Undertaking at the Anti Ragging Web Portal of Government of India

www.antiragging.in and submit the unique id/copy of undertaking generated online in the college office.

Parent's/Guardian's Name : NARINDER SINGH Applicant’s Name : SHREYA KAGRA

Signature of the Parent/Guardian ..................

          Dated ..................

Signature of the Applicant..................

Signature of the Parent/Guardian .............................

Dated : ...................

Signature of Applicant ....................................

Form No:- A44363

For Office use only

NOTE: This year due to Covid-19, verification of documents and admissions have been done online. Therefore, this admission is

provisional and if any information is found to be false/incorrect/concealed during physical verification (whenever) of the documents,

the admission stands cancelled and entire fee will be forfeited.

Recomendend for Provisional Admission Signature of Scrutineers

Percentage ........................................................................................

Original Document .............................................................................

Reservation, if any .............................................................................

Subject combination ..........................................................................

Gap year if any ..................................................................................

Convenor Coordinator Overall Incharge

Dated:.......................

Fee Paid(Rs.) _________________________________________ Receipt No. _______________________________ Dated __________________________

Hostel Fee Paid(Rs.) ___________________________________ Receipt No. _______________________________ Dated __________________________

Signature

InCharge Fee Collection