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AnnexureA
En.No.

Form No.

NALANDA OPEN UNIVERSITY

Affix Coloured
Photograph of
3 cm 4 cm

Biscomaun Bhawan, Gandhi Maidan, Patna800 001

ADMISSION FORM, 2016


(For IInd & IIIrd Year Students of All Courses)

Signature of the
candidate in English

vkosnd dk gLrk{kj fgUnh esa


1. Name of the applicant in Block letters in
Roman Script (as per Matriculation Certificate).
Leave one blank space between first,
second and third name.
2. Name of the applicant in Devanagari script

fgUnh esa viuk uke fy[ksa


3. Mother's Name.
4. Father's Name/
Husband's Name
5. Permanent Address.

Tel. No.

PIN

Tel. No.

PIN

6. Address for Correspondence

Mobile No.

E-mail

7. Name of the Programme/Course in which the admission is sought : .........................................................


8. Name of the Compulsory Subject : Hindi 100 Marks
or 50 Marks Hindi and 50 Marks Urdu
(For Intermediate and Graduation only)
9. Name of the Optional/Subsidiary Subjects 1............................. 2 ........................... 3............................
(For Intermediate and Graduation only)
10. Name of the Language & Literature subject : Hindi
(For the Intermediate courses only)
11. Date of Birth : Date
12. Gender (Male/Female)

Month

or English
year

13. Nationality

14. Religion

15. Category : SC/ST/BC-1/BC-II/WBC/Physically Handicapped/ General


16. Background (Urban/Rural/Tribal)
18. Status (Empolyed / Unemployed

17. Marital Status (Married/ Unmarried)


19. Choice of Language of SLM is needed
(See para 10 of Prospectus)

20. Name of the Study Centre

vxj vkius ukyUnk [kqyk fo'ofo|ky; ds fdlh ikB~;e esa iwoZ esa ukekadu djk;k
Fkk rks iwoZ esa fn, x, jftLVs'ku ua dk mYys[k ;gk vo'; djas A ijh{kk mkhZ.k gksus
dh n'kk esa vad i= dh Nk;kizfr layXu djsa A

21. Educational Qualifications : (Matriculation Onwards)


Name of the
Div./Class
Percentage of
Examination Passed
awarded
Marks

22. Specify any other qualification

Year of
Passing

Name of the
College/School

Name of the
Board University

: .................................................................

DECLARATION BY THE APPLICANT


I...............................................................(Name) hereby declare that I have read and understood the
condition of eligibility of the course for which I seek admission. I declare that I fulfil the minimum eligibility
criteria and have provided the required information in this regard in the admission form. In the event of any
information being found incorrect or misleading, my candidature shall be liable to be cancelled by the University
at any time and I shall not be entitled to refund of any fee paid by me to the University.
I also declare that I have not taken admission simultaneously in any other course during the same session
of the Nalanda Open University or any other institution.
I enclose Bank Draft No.
Demand Draft. No.

Date

Amount

Name of the Bank

Signature of the Candidate

FOR OFFICE USE


ELIGIBLE : Admit in........................................................................................Course/NOT ELIGIBLE : Rejected
Enrolment No. :

Signature of in-Charge Admission

fo|kFkhZx.k i;k ;ku nsa %


(i) viw.kZ vkosnu i=k dks vLohr dj fn;kAtkrk gS

(ii) ukyUnk [kqyk fo'ofo|ky; esa ,d 'kSf{kd l=k esa ,d ls T;knk ikB~;eksa esa ukekadu dk izkokku

,d ikB~;e esa v;;u lekIr gks tkus ds ckn gh nwljs ikB~;e esa ukekadu fy;k
A tk ldrk gS

A ds vanj
(iii) ukekadu lacakh =kqfV;ksa dk fu'kqYd fujkdj.k ukekadu frfFk lekIr gksus ds nks ekg

( ii )

AnnexureB

NALANDA OPEN UNIVERSITY


Examination Application Form

Affix Coloured
Photograph of
3 cm 4 cm

Year2017
(FOR ALL STUDETNS OF ALL YEARS)

Sir,
I request you for permission to appear at the............................................................................Part......
(Mention Name of the Course)

Examination to be held in..................................., 20........


I am required to be examined in the following subjects (Mention name of Subjects/Paper) :
1. .......................................................................... 2. ..........................................................................
3. .......................................................................... 4. ..........................................................................
5. .......................................................................... 6. ..........................................................................
7. .......................................................................... 8. ..........................................................................
9. .......................................................................... 10. ..........................................................................
1. Name in Full (in Roman Script)
(Block Letters Only)
2.

ijh{kkFkhZ dk uke

nsoukxjh fyfi esa


3. Enrollment No.
4. Registration No.

Year of Registration

5. Session of Study
6. Permanent Address

Tel. No.

PIN

Tel. No.

PIN

7. Correspondence Address

Signature of Verifying Officer

Signature of the Student

RECEIPT
Received Examination Form from Mr./Miss/Mrs...........................................................................
Enrolment No........................................on (date)...............................
(Signature of Receiving Officer)
( iii )

ijh{kk iQkeZ Hkjus gsrq funsZ'k


-

Nk=kksa dks ijh{kk iQkeZ ds :i esa nksAizi=k


igykfn;s
izi=k]
x;sftls
gSa
Examination Application Form
dgk x;k gS] esa Nk=kksa dks ijh{kk dk o"kZ] fo"k;Adk uke fy[kuk gS

Examination Application Form esa Nk=k viuk uke nsoukxjh rFkk jkseu fyfi esa fgUnh ,oa vaxzst
v{kjksa esa)] ukekadu(Enrolment
ekad Number), iath;u la[;k (Registration Number) ,oa vius

i=kkpkj dk irk vo'; fy[ksa


A iath;u ugha gksus ij Nk=kksa dks ijh{kk esa cSBus dh A
vuqefr ugha
-

Admitftls
Card dk uke fn;k x;k gS] esa Nk=kksa dks ikB;e
ijh{kk iQkeZ ds :i esa fn;s x;s nwljs izi=k
uke] viuk uke] ukekadu la[;k] iath;u la[;k ,oa oSdfYid @ lgk;d fo"k;ksa dk uke Li"V v{kjksa e
djuk gSA

cm gh
4 cm
photo dh
Nk=kksa dks iw.kZ :i ls Hkjs gq, ijh{kk iQkeZ ds lkFk3gky
esacoloured
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A

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rFkkCard ds fy, fn;s x;s izi=kksa esa ;Fkk LFkku iQksVks fpidkus ds ckn] fpfU
viuk gLrk{kj vo'; djsa
A

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A fy[ksa

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Admit Card Mkd ls Hkstus dh voLFkk esa] bu nksuksa iQkeks dks ,d gh fyiQ
Hkstsa
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( iv )