Pandit Prithi Nath College

Application Number:  195712 GEN

Applied for  -  B. Sc. (Mathematics, Physics, Statistics) [3rd Year]
DATE: 14-Jul-19

BASIC DETAILS

STUDENT NAME ARTI TIWARI GENDER F CANDIDATE PHOTO

FATHER NAME RATNESH CHANDRA TIWARI MOTHER NAME VIJAY LAXMI TIWARI

STUDENT MOBILE 8765594048 FATHER MOBILE 9452526740

EMAIL arti49141@gmail.com BIRTH DATE 22-Nov-2000

DOMICILE IN UP Yes

APPLICANT'S ADDRESS
ADDRESS LINE 1 69, ASHOK NAGAR GOVAGARDEN ROAD KALYANPUR KANPUR

ADDRESS LINE 2 69,ASHOK NAGAR GOVAGARDEN ROAD KALYANPUR KANPUR

STATE UTTAR PRADESH CITY Kanpur(Nagar) PINCODE 208017

OTHER DETAILS

COURSE B. Sc. SEM/YEAR 3rd Year AADHAR NO. 849854893728

(Mathematics,
Physics, Statistics)

RELIGION Hindu CATEGORY GEN CASTE CERTIFICATE NO. -

SUB CATEGORY No SUB CATEGORY CERTIFICATE NO. -

INDISCIPLINE BY ANY INSTITUTE No UNFAIR BY ANY INSTITUTE No

LAST INSTITUTE NAME PANDIT PRITHI

NATH PG
COLLEGE

LAST UNIVERSITY/BOARD NAME CSJM UNIVERSITY

SUBJECT SELECTION
Mathematics Statistics

ACADEMIC HISTORY
EDUCATION EXAM UNIV/BOARD MARKS INSTITUTE MAX AGG. ROLL MARKSHEET
LEVEL YEAR OBTAINED MARKS PERCENTAGE NO. NO
UG 2nd Year 2019 CSJM 187 PANDIT PRITHI NATH PG 500 37.4 5073393
UNIVERSITY COLLEGE

LAST EXAM DETAILS

EDUCATION LEVEL SUBJECT 1 SUBJECT 2 SUBJECT 3 SUBJECT 4 SUBJECT 5 SUBJECT 6
GOT MARK GOT MARK GOT MARK GOT MARK GOT MARK GOT MARK
UG 2nd Year Physics Mathematics Statistics 0 0 0
72 103 12
 PAYMENT DETAILS
AMOUNT 180
BANK REFERENCE NO 408089068
TRANSACTION ID 20190714133638327
DATE 7/14/2019 1:42:25 PM

DECLARATION

I hereby declare that I have thoroughly read the rules and regulations given in the admission brochure and accept terms and
condition given in it.

promise that, if admitted to the college, I will remain disciplined and not involve in any activity that hampers the academic or any
other programme conducted by the college.

I have mentioned all the facts regarding my admission requirements. In case these facts are found false /evaded, my admission
be cancelled and I will be liable to punishment. I will opt the subjects finally approved by the admission committee and fill only
those subjects in the university examination form .All the entries in the form have been filled by me.

I promise to abide by the above Para, failing which, my claim for admission be forfeited /withdrawn. I also declare that I have not
taken admission in any other institution /college in any course this year. I will regularly attend the classes. I will have no
objection if I do not receive scholarship on account of my attendance less than 75%.

INFORMATION FILLED BY MY SON/DAUGHTER/WARD IN APPLICATION FORM ARE THERE IN MY KNOWLEDGE

CANDIDATE SIGNATURE PARENT SIGNATURE

FOR OFFICE USE ONLY:

The annual fee amount Rs............................... has been deposited by the candidate ..............................................................

....................Registration No ............................................on ............................................ through fee Challan /Debit card

/Credit Card /Net Banking /Online Payment.

Recommendation of Admission committee:

Subject Recommended

....................................

....................................

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Verified By Signature convener Signature Principle