SIDDHARTH UNIVERSITY KAPILVASTU, SIDDHARTH NAGAR-272202

EXAM FORM FOR REGULAR EXAMINATION 2019-2020

Application / Registration No 1005005

University /Institute Name G.P.S. SNATKOTTAR MAHAVIDYALAYA, KHALILABAD, SANT KABIR NAGAR (423) [SANT
KABIR NAGAR]
Personal Details
Student Name SHIVAM PANDEY Date of Birth 17-02-1996
Mother Name RAJNI PANDEY Gender Male
Father Name SHYAM NARAYAN PANDEY Category General
Domicile UTTAR PRADESH Sub Category Not Applicable
Nationality Indian Aadhaar Number (UIDAI) NA
Blind Status No Religion Hindu
Course Apply Details
Course / Class For: Under Graduate(B.A.)[ III Year ]
Subject / Group Details ANCIENT HISTORY,ARCHAEOLOGY AND CULTURE (01) , SOCIOLOGY (37)
Paper Details ( 3001 ) ELEMENTS OF NUMISMATICS AND PALAEOGRAPHY (3001 ) , ( 3002 ) ANCIENT
INDIAN ART AND ARCHITECTURE (3002 ) , ( 3040 ) PERSPECTIVES IN SOCIOLOGY (3040
) , ( 3041 ) SOCIAL ANTHROPOLOGY (3041 ) , ( 4001 ) ANCIENT INDIAN RELIGION (4001
) , ( 4017 ) SOCIOLOGY OF MOVEMENTS IN INDIA (4017 )
Educational Details
Quaqllification Result Status Board / year of Passing Marks (%) Rollno Institute Name
University Name Address
10th or Passed CENTRAL 2012 72 5184316 UP
equivalent BOARD OF
SECONDARY
EDUCATION
Intermediate 12 Passed U.P.BOARD OF 2016 71 4125868 UP
or equivalent 10 AND 12
EDUCATION
Contact Details
Address GKP, GKP, GKP, GORAKHPUR
District GORAKHPUR State UTTAR PRADESH
Pin Code 000000 Email id NA
Mobile No 0000000000 Contact No NA
Fee Payment Details
Payment Mode EPG Transaction Id CH98701771
Exam Fee 1658 Date of Transaction 1/23/2019 2:15:46 PM
Payment Due Date 23/01/2019
Images Uploaded
Photograph Signature Thumb Impression

DECLARATION
I Solemnly declare that all the information made above are true to the best of my knowledge and belief. If any information is fond incorrect, my candidature can be cancelled.

Student Name in Hindi Father Name in Hindi Signature of Student

Certified that Sri / Km / Smt SHIVAM PANDEYis a bonafide Student of SIDDHARTH UNIVERSITY KAPILVASTU, SIDDHARTH NAGAR. All the documents of qualifying
examonations has been verified and found correct. Attendance is more than 75% and candidate is eligible for applied examination.
Date:

Signature of office Assistant Dean / HOD / Principal Signature

Submission Date: 22/12/2018 Print Date:11/02/2019 19:05:21