Candidate Type College/Deptt. Dept Roll No: College Admission Date: Entrance Test Rollno: Application No. Regd./PUPIN NO. Category Name of Candidate Father's Name Mother's Name Date of Birth ‘Aadhar NO. Gender Nationality Working in Government/Public Sector Mobile Email ID Correspondence Address Permanent Address Course Semester Current Subject(s) Course Semester/Year Result Panjab University, Chandigarh No need to submit this form to Panjab University . University Department (Full Subjects) UIET, PU Chandigarh 211050 0 1723164261 36921000162 General ROHIT SAHU BHARAT SAHU BHARATI SAHU, 12-01-2000 427721571462 Male Indian No 6207293979 [email protected] Adarsh nagar, Nayagaon,831016 Online Examination Form for Under Graduate Examination May 2023 [Payment'Type Bank TxnNo. || CPACNOZCM7 Name ROHIT SAHU Amount(Rs) 2835 Deposit Date |[03-03-2023 00:00:00 Branch Code 742, Parvati appartment £4 jojobera, Jamshedpur, Jharkhand,831016 B.E. (Bio-Tech.) 4 1. Chemical Reaction Engineering [BIO 413] 2. Chemical Reaction Engineering (Prac.) 3. Immunology & Immuno- technology (Prac.) 4, Educational Tour [BIO 416] 5, Molecular Biology [BIO 411] 6. Thermodynamics [BIO 412] 7. Industrial Biotechnology [BIO 414] 8. Industrial Biotechnology (Prac.) 9, Molecular Biology (Prac.) 10. Immunology & Immuno- technology [BIO 415] BE, BioTech) 3 Result AwaitedRoll No. 211050, Passing Year 2022 University Panjab University, Chandigarh Subject(s) Applied for Re-Evaluation No Blind/Permanently disabled from writing, Is MC No Is Environment Exam Passed No Applied For Environment Exam No have filed the form affer carefil study of the University sylabi, structural outiines of the course,rules and regulations pertaining to the year and session of the examination, under reference. The statements made by me in the form are correct. I accept fll ability for any action against me under the rules‘regulations of the University for any mis-statement or concealment of facts made by me. Place: Dat 03-03-2023 Full Signature of CandidatePanjab University, Chandigarh Certificates (For College/ Department of Evening Studies/University school of Open Learning Candidates) (Strike out which fz not applicable). 1, The candidate has remained on the rolls of this College/Department for the full academic year preceding the examination 2. The candidate has passed, at least one academic year previously (except in compartment ‘cases, appearing simultaneously), the lower examination with the required subjects and % age of marks on the basis of which he/she Is eligible to appear in the exam. 3, The candidate has attended not less than 75% of the full course of lectures delivered to his/her class in each of the paper being offered for examination, 4, The candidate has attended not less than 75% of periods assigned to practical work in each science subject or Psychology, Home Science or in the case of Geography, Map work and Practical and 80% each in the subjects of Physical Education and Defence and Strategic Studies. 5, The candidate has obtained at least 25% marks in the aggregate of all the combined results of (a) the house examination held in November/December and (b) the intemal assessment based on three monthly class tests held in August, September and October respectively. 6. This college has duly been granted affiliation by the Panjab University which is valid upto date in the Course(s) being offered by the candidate in his/her examination form and the number of candidates admitted and being sent for examination is within the strength sanctioned by the University for the Course/Session. 7. The candidate bears a good moral character, that he/she has filled in and signed this examination form in my presence and has further satisfied by production of authentic documents, that the statements made by him/her in the form are correct Place: ipal/Chairperson Deptt. of Evening Studies/University School of Open Learning with official stamp) Dated: ipal of the College/Chairperson (Name of the College/Department with offici Stamp) Full Name of the Pri Certificate for Late College Students (Colleges/U | certify that the applicant : - (a) has previously appeared in the examination under Roll No. in Session Year (b) has completed the prescribed course of lectures/practicals etc in the college or has been on the rolls of the Department ‘of Evening Studies/University School of Open Leaming from July 20__ to April, 20__ in the subject/s offered by him/her and has paid continuation fee of Rs. 40/- vide Receipt No. Dated, /ersity School of Open Learning/Evening Studies) (c) bears a good moral character, (@) has signed the examination form in my presence and satisfied me by production of authentic documents and the statements made by him/her are correct. Full Signature of the Principal of the Date: College/Chairperson U.S.0.L./D.E.S. (Last Attended) (With official Stamp)Certificate for Private Candidates (other than late college students) (Items not applicable may be struck off) | Certity that (know the applicant personally. He/she bears a good moral character. His/her attested photograph is affixed. He/she has ‘signed this examination form in my presence and has satisfied me by production of authentic documents that the statements made by him/her in the form are correct (i) The applicant has been in continuous senice since and will continue to be as such till the commencement of the examination. He/She has completed at least 3 year senice on 30th November preceding the year of examination (@) Name of institution/Organisation/Deptt. (b) Date of Joining (c) Rank/Designation i) He/She has not been a regular student of an affliated college during the academic year Preceding the examination, (iv) There is no Evening College/Evening Classes in any college at the place where the applicant is ‘employed OR he was not granted departmental permission to join the Evening College/Evening Classes by the employer due to the nature of his duties (Attach certificate) OR that the applicant was not granted admission in the Evening College/Evening Classes by the Principal. In case there are more than one Evening College/Classes, this certificate may be obtained from all of them, (This ccerlifcate is not needed by women candidates). (v) For Defence Personnel Only: (a) he/she is a bonafied (permanent) resident of District in the ‘State of Punjab/Haryana/Himachal Pradesh/Chandigarh (U.T.) (©) He has been working in the State since (Month), (Year) ‘and will continue tl the commencement of examination. Note : Teacher of Govt. Primary/Middle/High School should get their forms attested by the Distt. Education Officer/Circle Education Officer. (Signatures & Stamp of the Head of Institution/Organisation/Deptt. where candidate is. ‘employed or any other attesting authority) Name of the Attesting Authority(in Capitals) Designation: Dated: CHECK LIST OF DOCUMENTS/INFORMATION (To be supplied by the Private Candidates Only) If you did not attach the following documents, you may be declared Not Eligible. 1. Have you passed the qualifying examination from this University? Yes/No. if yes, there is no need to attach the original Detailed Marks Card. 2. (a) Have you passed the qualifying examination from the Board/University/Council other than Panjab University? Yes/No (0) fyes.attach the Original Detailed Marks and Migration Certificates from the Board/University/Council Have you got your examination form attested by a competent authority as prescribed by the Panjab University ?¥es/No Have you filled in all the columns of the examination form property and that no column has been left blank?Yes/No Have you attached three copies of your latest passport size photograph from one and the same negative?Yes/No Have you attached the SC/STIBC certificate issued by the competent authority if applicable)?¥es/No Have you paid late fee, adcitional fee, special fee etc. (if any)Yes/No Date (Full Signature of Candidate) (For Office Use only) ble Not El ble, ible Subject to Reasons, Dealing Official A.S.0, 0.S.E, Dealing Official © «AS.0, 0S ARE