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FORM NO.

: 2017/290

Course / Year : MPhil in Operational Research


Subject : Shubham Bansal
2017

College / Institution : Faculty of Mathematical


Department : Operational Research
Sciences

Category : General Basis of Admission : Entrance

List No. : Serial No. / Rank No. :


Full Name : Shubham Bansal Mobile Number : 9716399716

Date of Birth : 07-08-1994 Email : Shubham.bansal0100@gmail.com

Marital Status : Single College / Department : Operational Research

Last Examination Passed : Msc Operational


% of Marks :
Research

Delhi University Enrolment Number : KM-


Date of Registration (If Research Student) : --
1172/12

Nationality :
Permanent Residence Address : 2-400, Brij Vihar, Nainital Road, Haldwani Haldwani Uttarakhand 263139

Father Name : Sanjay Bansal Father Phone No. :

Father Occupation : Father Office Address :

Mother Name : Shalini Bansal Mother Phone No. :

Mother Occupation : Mother Office Address :

Parents Monthly Income :


ACADEMIC RECORD

Exam Year of
University Marks Obtained Subjects Max Marks % of Marks
Passed Passing

University
Hons 2270 2015 Statistics 3000 76
of Delhi

University Operational
M. Sc. 1318 2017 2000 66
of Delhi Research

(a) Course and year of study to which the applicant is admitted at the University of Delhi :MPhil in Operational
Research 2017
(b) Subject of Study :MPhil Operational Research
(c) Duration of the course :18 months
(d) Date of joining : 01-09-2017
(e) Department / Faculty : Faculty of Mathematical Sciences Campus :North campus

Details of the Scholarship / Fellowship Awarded, if any to the applicant for the Above course :

Any other information the applicant may like to give :


Duration of previous stay in Gwyer Hall As Regular Resident/Guest Resident with course of study :

Duration of previous stay in any other Hostel in Delhi University (including College Hostel) :

(A residence-cum-character certificate from the concerned Hostel is to be attached)

The Details of Employment :

(i) Organisation : (ii) Type of Job : (iii) Duration :

I, hereby, authenticate that the particulars given in this application by me are correct and no fact has been
suppressed to the best of my knowledge and belief.

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

____________________________________________________________________________________

DECLARATION TO BE SIGNED BY ALL RESEARCH STUDENTS

I, .. hereby declare that I am a bonafide research student pursuing


M.Phil / Ph.D in the Department of ........................ (mention subject), in the University of
Delhi and date of my registration is..............

I further declare that I am a full time student. If take up employment during the tenure of my residency in the
Hall, I undertake to inform the Hall Authorities about it immediately.

Signature of the Applicant

Name, designation, address and Name and Signature of the HOD or Dean of the Faculty
Signature of the Research Supervisor (with Department / Faculty stamp)

___________________________________________________________________________________________

NON-RESEARCH STUDENTS

CERTIFICATE TO BE SIGNED BY THE HEAD OF THE DEPARTMENT / PRINCIPAL OF COLLEGE


CONCERNED

Certified that Mr. ................................................................ is a bonafide, full time student of


.............................................................................. Class in the College / Department / Faculty of
.................................................. He is neither employed nor an ex-student.

His position in the Admission/Merit List No. and rank No. . with Sr. No.

Date............................. Name and Signature of the Head / Dean


(with Seal of the Department / Faculty)
_____________________________________________________________________________________________

FOR FOREIGN STUDENTS ONLY

(i) Passport No.: ...................................... (ii) Visa valid upto ..........................................

(iii) Recommendation of the Deputy Dean, Foreign Students, University.

Dy. Dean, Foreign Students

(iv) Recommendation of the concerned Embassy:

Name of the recommending authority ...................................................................................

Designation .............................................................................................................................

Signature with official seal/stamp

In addition to the above recommendations, foreign students are also required to produce a Medical Certificate
from the National Institute of Communicable Diseases, 22 Sham Nath Marg, Delhi 110 054 as per the terms of
letter No. F.14-6-86-ES II of 20th April 1987 from the Ministry of Human Resource Development, Department
of Education, Government of India, New Delhi.

_____________________________________________________________________________________________

FINANCIAL GUARANTEE AND DECLARATION BY THE APPLICANTS LOCAL GUARDIAN

I certify that the applicant is seeking admission with my consent and that I shall be responsible for his conduct
and financial liabilities to the Hall.

Signature of Local Guardian ............................................................

Name of the Local Guardian .............................................................

Relationship with the candidate............................................................

Residential Address..............................................................................

Official Address....................................................................................

Contact No. Office..........................Residence..................Mob............

___________________________________________________________________________________________
DECLARATION BY THE CANDIDATE

1. This application is being made in full knowledge of my parents and local guardian.
2. I vouch for the correctness of the particulars given by me in the application form. I understand that if the
particulars given by me are found to be incorrect, my admission will stand cancelled.
3. I declare that my parents do not reside in the NCT Delhi.
4. I declare that I have passed the examination of the last course attended.
5. I declare that I am not an ex-student.
6. I declare that I am neither employed nor am I doing any paid job anywhere, full time or part time. If I take up
employment, I shall inform the Hall authorities immediately.
7. I declare that in case I am absent myself from the Hall for more than one month without intimating the Hall
Authorities, the Hall authorities have the right to get my room vacated.
8. I understand that the Provost, Warden, Resident Tutor and Caretaker of the Hall have the authority to enter
my room and to make a surprise check of the room as and when considered necessary by them.
9. I understand that all Hall and Mess dues are payble in advance by the 10th day of each month without late fee
fine. I also understand that in case my outstanding Hall / Mess dues at any time exceed Rs. 5000/-, my room (if
single seated would be double-locked and in case of double seated room, my belongs would be taken into
custody by the Hall Authority till such time that the outstanding dues are cleared by me.
10.. I understand that I cannot change the room allotted to me in the Hall without written permission of the
Hallauthorities. I undertake to leave all the furniture items and fixtures intact in the room from which I shift and
also in the room in which I shall be staying at the time of my leaving the Hall. I understand that I am liable to be
charged for loss or breakage of any Hall furniture or fixtures as per decision of the Hall authorities.
11. I undertake that I will not keep any unauthorized guest in my room.
12. I undertake that I will vacate the room/seat after not more than seven days of the last annual examination.
13. I undertake to hand over the complete charge of the room before leaving the Hall at the end of the course.
14. I have read the rules and regulations of the Hall contained in the Handbook of Information 2017-2018
under the Clause Discipline (General Rules and Regulations) and elsewhere in the Handbook and undertake to
abide by them. I shall not plead ignorance of regulations that may be notified from time to time also.
15. I also undertake to submit myself to the disciplinary jurisdiction of the Vice-Chancellor, the Provost and
other authorities of the University and Hall, who may be vested with the authority to exercise discipline under
the Act, the Statutes, the Ordinances, including Ordinance XV (B) and XV (C) (as stated in the Handbook of
Information 2017-2018), and the Rules framed by the University and Hall from time to time.

Date.................................... Name and Signature of the Applicant

Bank Details for making Payment :


Account Name : Gwyer Hall
Account Type : Current Account Bank : State Bank of India
Branch : Utility Center, Delhi University Account No.: 10851294984
IFS Code : SBIN0001067

Payment Transaction details :


Bank Name : Transaction ID :
Date : Amount :
ACKNOWLEDGEMENT

(To be filled in by the Applicant)

Received Application Form from ........................................................... on ................................................. for the

academic year 2017-2018.

(Signature of the Dealing Assistant)

Note:

1. The Applicants are advised to check the office Notice Board regarding their admission/interview etc. of the

Hall. No INDIVIDUAL COMMUNICATION will be sent.

2. All the entries must be filled in CAPITAL LETTERS. Incomplete Form will be rejected..