APPLICATION FORM (PG PROGRAMS)

SESSION

MEWAR UNIVERSIT Y

2 0 1 5 - 1 6

(A university u/s 2(f) of the UGC Act 1956 with the right to confer degrees
u/s 22(1) of the UGC Act; set up by Rajasthan Govt. Act 4 of 2009)

INSTRUCTIONS :

(Member, Association of Indian Universities)

1.
2.
3.
4.
5.
6.

Gangrar, Chittorgarh, (Rajasthan)-312 901

Ph. 01471-220881/2/3/4, Fax: 01471-220886
Website: www.mewaruniversity.org

Incomplete Application Form will not be considered

Read Prospectus carefully before filling the Application Form
Use Black / Blue Ball Pen only to fill the Application Form
Write the details in BLOCK LETTERS only
Demand Draft should be in favour of Mewar University payable at Chittorgarh/Ghaziabad
Tick Mark ( ) the appropriate box only

FOR OFFICE USE ONLY

Course Applying for

M.Tech

M.Sc

M.Com

M.A.

MBA

Executive MBA

Affix your
latest passport
size colour
photograph
within the box

Specialization/Branch
Are you GATE Qualified?

No If yes, valid GATE percentile

Yes

Year
D

PERSONAL INFORMATION (Exactly as appears in the certificate of qualifying examination)

Date of Birth

Student's Name

Male

Father's Name

Gender

Mother's Name

Nationality Indian

Category

SC

ST

OBC

Minority

General

Address for Correspondence

Permanent Address

Name

Name

Address :

PH

Female
Other
Internal

Address :

.
City :

District :

State

Pin Code :

City :

District :

State :

Pin Code :

Mobile Number (Self)

Telephone Nos. with STD code

Mobile Number (Second)

E-mail

Payment Details
Demand Draft / Payorder No. / Cash Receipt No. ............................................................... Dated ............................ Drawn on ..................................................
Branch .............................................................. for Rs. 1000 (rupees one thousand only) (The Demad Draft/pay order of Rs. 1000 (rupees one thousand only)
is to be drawn in pavour of MEWAR UNIVERSITY payable at Chittorgarh/Ghaziabad as Registration Fees.)

QUALIFYING EXAMINATION PARTICULARS

Name of Qualifying Exam
Discipline (Applicable)
Duration & Year of Passing
Name of College/ Institute
Basis of Admission

Entrance Exam

Left Hand Thumb Impression of the Candidate

Interview

Merit

Signature of the Candidate

ACADEMIC QUALIFICATIONS
Exam/Degree

Name of Institute,
Board/University

Year of
Passing

Medium of
Instruction

% of Marks/CGPA/
Overall Grade

Subjects

10th (Matriculation) or
its Equivalent
12th (Intermediate) or
its Equivalent
Graduation or its
Equivalent
Post Graduation or its
Equivalent
Other (if any)

EXTRA CURRICULAR ACTIVITIES

(Furnish in brief the particulars of achievements in sports/cultural/and other co-curricular activities)
Particulars of Activity

Year

Level (College/
State/National)

Achievement with remarks (if any)

DETAILS OF DISCIPLINARY ACTION (If any)

Has any disciplinary action been taken against you :
(If yes, please furnish the following details)

No

Yes

Particulars of Disciplinary Action

Year

Name of the Institution

LIST OF ENCLOSURES
Sr.
No.

Particulars

1.

Attested copy of matriculation or its

equivalent certificate for DOB testimony

2.

Attested copy of marksheet of

qualifying examination

3.

One recent passport size coloured

photograph

4.

Proof of payment (Demand Draft/Receipt

of cash deposited)

5.

Migration/Transfer Certificate

6.

Caste/Category Certificate (if applicable)

Mark 'NA'
if not
applicable

Marks 'O' if
submitted in
original and 'X' if
Xerox is Submitted

If pending for
submission
(Specify date of
submission)

Office remarks

Declaration & Certification

I, the undersigned, hereby declare and certify that:
(i)

All information hereby submitted and stated by me during the course of admission and related thereto, to the best of my knowledge and belief is complete, true and
factually correct and all the supporting to this form submitted to Mewar University are authentic. I undertake that I would be subject to all sorts of disciplinary action that
University may deemed fit to take against me including but not restricted to cancellation of my admission or expulsion or rustication and other actions as per applicable
laws, in case the documents and information submitted and stated herewith found false, incorrect or misrepresented by me.

(ii)

The University has all the rights to accept my admission or reject the same; mere submission of form along with fee does not mean that admission has been confirmed. The
admission would be understood as confirmed when the University will issue the admit card or do such act that pertains to confirmation of admission.

(iii)

In case of my withdrawal from the programme for any personal reason or due to expulsion or rustication from the University on disciplinary actions, I would not be entitled
for any refund of fees or other amount paid.

Name in BLOCK LETTERS

Date

Signature of Candidate

NOTE : PHOTOCOPY OF THE FILLED APPLICATION FORM MUST BE RETAINED BY THE CANDIDATE FOR FURTHER USE.