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SWAMI VIVEKANAND

SUBHARTI UNIVERSITY
APPLICATION FORM
NOTE :

APPLICATION NUMBER

1. Read the prospectus carefully and General Instructions before filling up the Form.
2. Use only BLUE or BLACK pen to fill up the form.
3. Fill the form in English using CAPITAL / BLOCK LETTER only.
4. Do not fold, staple or clip the from.
1. NAME OF THE APPLICANT

2. DATE OF BIRTH

DATE

MONTH

3. SEX (Tick appropriate one)

YEAR

MALE

4. NATIONALITY

FEMALE

5. COURSE : write full name of the course.


COURSE ....................................................................................................................................................................................................
....................................................................................................................................................................................................................
6. CATEGORY (Submit Proof)
7. (a) NAME OF FATHER :

7. (b) NAME OF MOTHER :

7. (c) ANNUAL INCOME OF YOUR FAMILY (PARENTS)

8. ADDRESS FOR CORRESPONDENCE (DO NOT REPEAT NAME)

9.1 CITY

9.2 PINCODE

10. TELEPHONE NUMBER (WITH STD CODE)

11. MOBILE NUMBER

12. E-MAIL ADDRESS

13. ALTERNATE E-MAIL ADDRESS

14. PHOTOGRAPH

PASTE your recent self


attested passport size
colour photograph.
DO NOT STAPLE

15. SIGNATURE OF APPLICANT

16. LEFT THUMB IMPRESSION OF APPLICANT

(Sign inside the box without touching edges)

(Please use stamp pad for impression)

17. DETAILS OF 10+2 or equivalent


SCHOOL/
COLLEGE

PASSED

BOARD

SUBJECT

APPEARING

MARKS
MAXIMUM

MARKS
OBTAINED

PERCENTAGE
(%) OF MARKS

MONTH &
YEAR

1.
2.
3.
4.
5.
6.
7.
8.
TOTAL
18. DETAILS OF QUALIFYING EXAMINATION (Only for PG/Diploma)
QUALIFYING
EXAM

SCHOOL/
COLLEGE

BOARD/
UNIVERSITY

YEAR/
SEMESTER

MARKS
MAXIMUM

MARKS
OBTAINED

(%)
OF MARKS

MONTH &
YEAR

I YR/ I SEM
I YR/ II SEM
II YR/ III SEM
II YR/ IV SEM
III YR/ V SEM
III YR/ VI SEM
IV YR/ VII SEM
IV YR/ VIII SEM
TOTAL
DETAILS OF SCORE CARDS (GATE / MAT / GMAT / CAT / XMAT etc.)....................................................................................................
........................................................................................................................................................................................................................
19. DD NUMBER

DD DATE

DD AMOUNT

ISSUING BANK NAME WITH BRANCH CODE

(Write Application Number and your Name with address on the reverse of the Demand Draft)
20. Details of Manufacturing/Service units (If any) owned by your Parents/guardians/known............................................................
........................................................................................................................................................................................................................
21. DECLARATION

I hereby declare that I have carefully read the instructions and all the particulars stated in this application form are true and correct to
the best of my knowledge and belief. If any of the information provided is false I shall abide by the actions and decisions taken by the
Swami Vivekanand Subharti University.

SIGNATURE OF PARENT / GUARDIAN

SIGNATURE OF APPLICANT

Date :

Date :

Place :

Place :

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