UNIVERSITY OF LUCKNOW

LUCKNOW
Admissions 2019 – 20
Rank wise Cutoff for Off Campus Online Counselling

B.Com. /B.Com (Hons)

§ Options Available
o B.Com. (Hons)
o B.Com.
§ Allotment will be done strictly on the basis of overall rank of the candidate as
well as the subject they have selected in order of preference during choice
filling. Allotment in B.Com (regular) would be done first followed by B.Com.
(Self Financed) according to merit.

Category Open Rank From Open Rank to

Open 1 1750

General Subcategory General Ranks

General DP 102, 122, 133, 264, 276, 360, 437, 573, 795, 1064, 1114, 1381,
1440, 1453, 1459, 1525, 1553, 1554, 1591, 1791, 1950, 2065,
2095, 2139, 2360, 2364, 2493, 2596, 2676, 2724, 2764, 2786,
3013, 3039, 3052, 3128, 3144, 3172, 3381, 3420, 3451, 3474,
3705, 3809, 3820, 3971, 4358, 4507, 4614, 4745, 4782, 4824,
4854
General FF 387, 2340, 2468, 6773
General PH 40, 149, 3635, 3732, 4550, 5528, 6590, 6774, 8225
General UE 1808, 1856, 2661, 2840, 3072, 3334, 3508, 5264, 5975, 6152,
6222, 6624, 6813, 6826, 7679, 7953, 8114, 8661

Category OBC Rank From OBC Rank to

OBC BC0001 BC0900

OBC Subcategory OBC Ranks

OBC DP BC0072, BC0094, BC0207, BC0240, BC0244, BC0367, BC0443,
BC0553, BC0596, BC0643, BC0795, BC0845, BC0876, BC1388,
BC1442, BC1623, BC1656, BC1698, BC1699, BC1942
OBC FF BC1311, BC1952
OBC PH BC0567, BC1360, BC1652
OBC UE BC1092, BC1268, BC1456, BC1814, BC1824, BC1839, BC1900,
BC1920, BC1955, BC1963
OBC CT

Category SC Rank From SC Rank to

SC SC0001 SC0632

SC Subcategory SC Ranks
SC DP SC0002, SC0189, SC0242, SC0325
SC PH SC0019

Category ST Rank From ST Rank to

ST ST0001 ST0031

ST Subcategory ST Ranks
ST DP ST0004
ST UE ST0024
· All interested candidates whose ranks are given above are eligible to participate in the Online Off Campus
Counselling. Candidates are advised to read the counselling guidelines carefully and use their discretion
whether to participate in the counselling or not.
· Allotment will be done strictly on the basis of overall rank as well as the availability of seat they have
selected in order of preference during choice filling
· Merely participating in the counselling does not guarantee admission.
 University of Lucknow
Lucknow
Admissions 2019
Counseling Procedure and Guidelines

Programs
§ University of Lucknow will be adopting an Off Campus Online Counseling for the
following programs.
o Undergraduate Programs
§ LL.B. (5 Year)
§ B.Com.
· B.Com. (Hons)
· B.Com. (Regular)
· B.Com. (Self Financed)
§ B.Sc. Mathematics Group
· Physics, Chemistry & Mathematics
· Physics, Mathematics & Statistics
· Physics, Mathematics & Geology
· Physics, Mathematics & Astronomy
· Physics, Mathematics & Computer Science
· Mathematics, Statistics & Computer Science
· Physics, Mathematics & Computer Science (Self Financed)
§ B.Sc. Biology Group
· Chemistry, Botany & Zoology
· Zoology, Botany & Geology
· Geology, Botany & Chemistry
· Botany, Geology & Anthropology
· Zoology, Botany & Anthropology
· Zoology, Geology & Anthropology
· Genetics & Genomics*, Chemistry & Botany
§ BCA
§ B.Voc (Renewable Energy)
§ UG Management (BBA/MBA 5 year)
· MBA (5 YEARS)
· BBA
· BBA (International Business)
· BBA (Management Sciences)
· BBA (Tourism)
§ BVA/BFA
· BVA (Painting)
· BVA (Applied Art)
· BVA (Sculpture)
· BFA (Textile Design)
§ Diploma Programs in Fine Arts
· Art Master Training
§ B.El.Ed.

General Guidelines
§ In the first step candidates have to register and submit choices.
§ Only candidates within the declared rank can participate in the online counseling.
§ There will be On Campus Online Counseling for B.A and B.A. (Hons).
Candidates will have to report at the designated counseling centre for counseling.
 University of Lucknow
Lucknow
Admissions 2019
Counseling Procedure and Guidelines

Counseling Schedule

Day wise Activity

May 28, 2019 to June 10, 2019 Registration and Choice Filling

Documents to be uploaded
§ Intermediate mark sheet
Reservation Documents (As needed)
§ Caste Certificate
§ Income Certificate
§ Any other for EWS

June 11, 2019 To June 12, 2019 Only Choice Filling

June 15, 2019 (after 5:00 PM) First Allotment Result

June 15, 2019 (after 5:00 PM) To June 18, 2019 Seat Confirmation Fee Payment

June 21, 2019 (after 5:00 PM) Second Allotment Result

June 21, 2019 (after 5:00 PM) To June 24, 2019 Seat Confirmation Fee Payment

June 27, 2019 Further process would be announced for

remaining seats (if any)
 University of Lucknow
Lucknow
Admissions 2019
Counseling Procedure and Guidelines

Important Instructions
· Document Required for Upload
o Scanned copy of Documents Required before Counseling
§ For General
· Intermediate Mark sheet
§ For OBC (Creamy Layer)
· Intermediate Mark sheet
§ For General (EWS)
· Intermediate Mark sheet
· Certificates as per Government directives.
§ For OBC (Non Creamy Layer)
· Intermediate Mark sheet
· Valid Caste Certificate
· Income Certificate issued after January 1, 2019
§ For SC/ST (Non zero fee)
· Intermediate Mark sheet
· Valid Caste Certificate
§ For SC/ST (Zero fee)
· Intermediate Mark sheet
· Valid Caste Certificate
· Income Certificate issued after January 1, 2019

· All documents would be verified online through Government websites.

· In case, the documents are found incorrect/fake or the benefit has been
falsely claimed by the candidate, they will be debarred from participating in
the admission process any further.
 University of Lucknow
Lucknow
Admissions 2019
Counseling Procedure and Guidelines

COUNSELING PROCEDURE

Step 1: Registration
· Only candidates within the declared rank can participate in the online
counseling. This will be announced along with declaration of the entrance test
result.
· Interested candidates have to register through the login credentials provided
to them at the time of form filling.
o In case they have forgotten the password they can regenerate it
through the link provided on the admission portal.
· The following have to be done during registration
o Enter the total marks obtained of all subjects in class 12 examination
and upload the class 12 marks sheet.
o Enter the bank account details of either self or father or mother
§ This will be required for refunding the advance fee if seat is not
allotted. Registration fees can be paid from any bank account.
o For SC and ST candidates who want the benefit of zero fee have to
upload and provide details of proper income certificate issued after
January 1, 2019 or the validity of certificate printed in the income
certificate.
o For General candidates who want the benefit of 10% reservation for
Economically Weaker Section (EWS) have to upload and provide
details of proper certificates as per Government directives.
o All candidates have to pay Rs. 3200 (Rs. 3000 as advance fee which is
refundable and Rs. 200 as Registration fee which is non refundable)
through online modes (Net banking, Debit Card and Credit Card) only.
Details of fee to be deposited at various stages are given in Table 1.
§ In case the candidate is not allotted a seat the advance fee of
Rs. 3000 would be refunded into the account details provided by
them.
§ If the candidate is allotted a seat then the advance fee will be
adjusted in the total fee for that program.
§ In case the candidate is allotted a seat and she/he does not
deposit the seat confirmation fee, the advance fee of Rs.
3000.00 will not be refunded.
§ The registration fee is non refundable under any circumstances.
o Only registered candidates will be able to fill the choices.
Step 2: Choice Filling
· Candidates registered for counseling have to fill their choices of
subject/college (for B.El.Ed.) according to their preferences.
o Candidates can give as many choices as they want.
o Lower rank candidates are advised to give more choices so that they
are not denied allotment.
o Candidates have to submit choice even if counseling is for a single
option
§ e.g. LL.B. (5 year), BCA or B.Voc (Renewable Energy)
o Choices can be rearranged any number of times till final submission
 University of Lucknow
Lucknow
Admissions 2019
Counseling Procedure and Guidelines

· Candidates can take a print out of the submitted choices even without locking.
This is being done so that they can go through it and decide on the sequence
of subject/college (for B.El.Ed.) that they want.
· Choices can be filled in multiple sessions. There is option to save these
choices before logging out. Data not saved will be lost.
· The choices filled by the candidate are final and cannot be changed
once locked.
o If a candidate has submitted the choices but not locked after last date
of choice filling is over, it will automatically be locked before seat
allotment.
o If the candidate has registered for counseling but not submitted the
choices, she/he would not be considered for seat allotment.
· Seat allotment result will be available on candidate login.
· All allotments would be provisional and subject to verification of documents on
reporting to the University/College (for B.El.Ed.). The admission of such
candidates whose documents are not found to be in order would be cancelled.

Step 3: Seat Allotment

· Allotment will be done strictly on the basis of overall rank of the candidate as
well as the subject/college (for B.El.Ed.) they have selected in order of
preference during choice filling.
· Seat allotment result will be available on candidate login only.

Step 4: Seat Confirmation and Provisional Allotment cum Confirmation

letter download
· Candidates who have been allotted a seat will have to download Provisional
Allotment cum Confirmation letter through the Lucknow University website
after paying the balance amount of fee given in Table 1.
· The candidates who have not been allotted their first preference can opt
for upgradation.
o They have to give the option whether they want to retain the allotted
subject/college (for B.El.Ed.) or they want to go for the upgradation
process.
· In case of up gradation they would be allotted a subject/college (for B.El.Ed.)
of higher priority or the same subject/college (for B.El.Ed.) depending upon
the vacancy. In no case a subject/college (for B.El.Ed.) of lower priority can
be allotted.
· Candidates who opt for upgradation have to pay the seat confirmation fee as
given in column 5 of Table 1 but they will be given the provisional allotment
cum confirmation letter only after the next allotment. The fee paid would be
adjusted against the finally allotted subject/college (for B.El.Ed.). However
they will have to pay the difference of fee (if any) as given in column 6 of
Table 1 to get the provisional allotment cum confirmation letter.
· Candidates who opt to retain the allotted college can download their
provisional allotment cum confirmation letter after paying the subject/college
(for B.El.Ed.) confirmation fee as given in column 4 of Table 1.
 University of Lucknow
Lucknow
Admissions 2019
Counseling Procedure and Guidelines

o SC and ST candidates who have opted for zero fees and have
uploaded their income certificate can directly download this provisional
Allotment cum Confirmation letter. However they have to get their
proper income certificate verified at the University/allotted college. In
case the certificate is found to be incorrect they will have to pay the
remaining amount of balance fee at the University/college.
Step 5: Report to University/Allotted College
· The candidate has to report to office of the Concerned Dean/Principal of the
allotted college (for B.El.Ed.) within four days from the date of allotment with
all the original documents along with provisional allotment cum confirmation
letter.
· The original documents will be physically verified by the Concerned
Dean/Principal of the allotted college.
· If the documents of candidates are not found valid during verification, his/her
candidature shall be cancelled. In such case fee paid will not be refunded.
· Documents required for reporting
o Candidates would need to carry the originals and self-attested copy of
the following documents:
· Printout of the provisional Allotment cum Confirmation letter from
Lucknow University Portal
· Copy of Application form and Admit Card.
· Proof of Date of Birth: Class 10thcertificate
· All Mark Sheets and Certificates up to Qualifying Examination.
· Category Certificates in original in the prescribed format,
· Original photo ID issued by Government
· Two passport sized photographs
· Copies of all Fees Receipts
· Income certificate if zero fees claimed.

Step 6: Second Allotment

· Second allotment would be carried out by the online process on Merit Cum
Option basis on choices submitted by candidates in step 2 of these
guidelines.
· Up gradation and allotment would be done simultaneously.
· The following candidates would be included in second allotment.
o All candidates who were seat in first allotment and have paid the seat
confirmation fee with option for upgradation.
o All candidates who had filled their choices but were not allotted any
seat during first allotment.
· The following candidates would not be considered during the second
allotment process
o Those who were allotted seat during first allotment but did not pay the
seat confirmation fee.
o Those who were allotted college in first allotment and have opted to
retain the allotted college.
· Second allotment would result in upgradation of allotment for candidates who
have confirmed seats and have opted to upgrade.
 University of Lucknow
Lucknow
Admissions 2019
Counseling Procedure and Guidelines

o In such case the candidate would be allotted a seat in choice of higher

priority or the same choice depending upon the vacancy.

Step 7: Seat Confirmation and Provisional Allotment cum Confirmation

letter download after second allotment
· Candidates who have been allotted seats in the second allotment have to
confirm their seat by paying the balance fee as given in column 6 of table 1.
They would be able to download their provisional allotment cum confirmation
letter after payment of the fee.

Step8: Report to University/Allotted College after second allotment

· The candidate has to report to office of the Concerned Dean/Principal of the
allotted college (for B.El.Ed.) within four days from the date of allotment with
all the original documents along with provisional allotment cum confirmation
letter.
· The original documents will be physically verified by the Concerned
Dean/Principal of the allotted college.
· If the documents of candidates are not found valid during verification, his/her
candidature shall be cancelled.
· Documents required for reporting
o Candidates would need to carry the originals and self attested copy of
the following documents:
· Printout of the provisional Allotment cum Confirmation letter from
Lucknow University Portal
· Copy of Application form and Admit Card.
· Proof of Date of Birth: Class 10thcertificate
· All Mark Sheets and Certificates upto Qualifying Examination.
· Category, sub category and weightage Certificates in original in the
prescribed format,
· Original photo ID issued by Government
· Two passport sized photographs
· Copies of all Fees Receipts

Step 9: Subsequent Allotment

· If needed further choice filling and allotment would be done on
remaining seats (if any). Details of this would be announced after
fee submission for second round of counseling is completed.
 University of Lucknow
Lucknow
Admissions 2019
Counseling Procedure and Guidelines

Table 1 Fee Details for various phases of counseling

#
Program Fee Registration Advance Confirmation Fee Confirmation Fee for Balance
Fee Fee Upgrade Fee
1 2 3 4 5 6

B.Sc. (Mathematics Group)

Physics, Chemistry & Mathematics 9277* 200 3000 6277 6277 0
Physics, Mathematics & Statistics 9277* 200 3000 6277 6277 0
Physics, Mathematics & Geology 10777* 200 3000 7777 6277 1500
Physics, Mathematics & Astronom 9277* 200 3000 6277 6277 0
Physics, Mathematics & Computer Science* 12277* 200 3000 9277 6277 3000
Mathematics, Statistics & Computer Science 12277* 200 3000 9277 6277 3000
Physics, Mathematics & Computer Science
14580* 200 3000 11580 6277 5303
(Self Financed)
B.Sc. (Biology Group)
Chemistry, Botany & Zoology 11277* 200 3000 8277 8277 0
Zoology, Botany & Geology 12777* 200 3000 9777 8277 1500
Geology, Botany & Chemistry 12777* 200 3000 9777 8277 1500
Botany, Geology & Anthropology 12777* 200 3000 9777 8277 1500
Zoology, Botany & Anthropology 11277* 200 3000 8277 8277 0
Zoology, Geology & Anthropology 12777* 200 3000 9777 8277 1500
Genetics & Genomics, Chemistry & Botany 24277* 200 3000 21277 8277 13000
Bachelor of Computer Application
Bachelor of Computer Application 36080* 200 3000 33080 No Upgradation -
B.Voc.
B.Voc. (Renewable Energy) 7380* 200 3000 4380 No Upgradation -
LL.B. (5 Year)
LL.B. (5 Year) 26580* 200 3000 23580 No Upgradation -
B.Com.
B.Com. (Regular) 5277* 200 3000 2277 2277 0
B.Com. (Self Finance) 17080* 200 3000 14080 2277 11803
B.Com. (Hons) 29580* 200 3000 26580 2277 24303
UG Management
MBA (5 YEARS) 42080** 200 3000 39080 28080 11000
BBA 41080** 200 3000 38080 28080 10000
BBA (International Business) 41080** 200 3000 38080 28080 10000
BBA (Management Sciences) 41080** 200 3000 38080 28080 10000
BBA (Tourism) 31080* 200 3000 28080 28080 0
BVA/BFA
BVA/BFA (Regular) 10072 200 3000 7072 7072 0
BVA/BFA (Self Financed) 20330 200 3000 17330 7072 10258
Diploma Programs in Fine Arts
BVA/BFA (Regular) 12580 200 3000 9580 9580 0
B.El.Ed.
B.El.Ed. 40000 200 3000 37000 0 0
* Includes Rs. 1000 as enrolment fee.
** Includes Rs. 1000 as enrolment fee and Rs. 5000 as caution money.
In case the candidate is already enrolled in the University of Lucknow they have to enter the enrolment number and this fee would not be charged.
#
The fee mentioned is for semester 1 only.
 उ र दे श शासन
कािमक अनुभाग-2
सं या-3/2019/4/1/2002/का-2/19ट .सी.-II
लखनऊ, दनांक : 14 माच, 2019

कायालय- ाप

सामा जक याय एवं अिधका रता मं ालय, भारत सरकार, नई द ली ारा िनगत
अिधसूचना दनांक 12.01.2019 के मा यम से भारत का सं वधान म 103वां संशोधन करते
हु ये सरकार सेवाओं क सभी े णय म िनयु के िलये व अ पसं यक सं थाओं को
छोड़कर सरकार व िनजी शै णक सं थान ( अनुदािनत एवं गैर अनुदािनत ) म वेश के
िलये आिथक प से कमजोर वग के िलये अिधकतम 10 ितशत का आर ण अनुम य
कया गया है ।
2. समाज क याण वभाग, उ0 0 शासन के आदे श सं या-325/26-3-2019, दनांक-
22.01.2019 के म म कािमक अनुभाग-2 के कायालय- ाप सं या-
1/2019/4/1/2002/का-2/19ट .सी.-II , दनांक 18.02.2019 ारा रा य सरकार क
सरकार सेवाओं क सभी े णय म सीधी भत के म पर िनयु के िलये तथा
अ पसं यक सं थाओं को छोड़कर सभी सरकार व िनजी शै णक सं थाओं (अनुदािनत एवं
गैर अनुदािनत) म वेश के िलये आिथक प से कमजोर वग के िलये अिधकतम 10
ितशत आर ण दान कये जाने हे तु आदे श िनगत कये गये ह। उ कायालय- ाप
दनांक 18.02.2019 के तर-4 के उप तर-(ख) (iii) म प यव था द गई है क
प रवार क आय और प रस प का माण प स ब धत े के तहसीलदार से अिन न
अिधकार ारा मा णत/जार कया जायेगा।
3. शासन के सं ान म यह लाया गया है क विभ न तर पर वांिछत आय एवं
प रस प माण प िनगत नह ं कये जा रहे ह। अत: इस स ब ध म स यक्
वचारोपरा त आिथक प से कमजोर वग के िलए लागू आर ण यव था हे तु वांिछत आय
एवं प रस प माण प का प -I व प -II िनधा रत कया गया है ।
4. इस स ब ध म अधोह ता र को यह कहने का िनदे श हु आ है क संल न प -I व
प -II के अनुसार उ आिथक प से कमजोर वग के य य के िलए माण प जार
कया जाना सुिन त कया जाय।
संल नक-यथो ।
मुकुल िसंहल
अपर मु य सिचव।

1- यह शासनादे श इले ािनकली जार कया गया है, अत: इस पर ह ता र क आव यकता नह है ।

2- इस शासनादेश क मा णकता वेब साइट http://shasanadesh.up.nic.in से स या पत क जा सकती है ।
 2

सं या-3/2019(1)/4/1/2002/का-2/19ट .सी.-II , त नांक।

ितिल प िन निल खत को सूचनाथ एवं आव यक कायवाह हे तु े षत:-

1) सम त अपर मु य सिचव/ मुख सिचव/सिचव, उ र दे श शासन।
2) सम त म डलायु / जलािधकार , उ र दे श।
3) सम त वभागा य / मुख कायालया य , उ र दे श।
4) सिचव, राज व प रषद, उ र दे श।
5) सिचव, उ र दे श लोक सेवा आयोग, यागराज।
6) सिचव, उ र दे श अधीन थ सेवा चयन आयोग, लखनऊ।
7) िनदे शक, सूचना, उ र दे श।
8) िनदे शक, राजक य मु णालय, लखनऊ को 200 ितयॉ मु त कराकर कािमक
अनुभाग-2 को उपल ध कराने हे तु ।
9) वेब अिधकार / वेब मा टर, िनयु एवं कािमक वभाग, उ र दे श।
10) सिचवालय के सम त अनुभाग।

अर व द मोहन िच ांशी
वशेष सिचव।
 3

कायालय- ाप सं या-3/2019/4/1/2002/का-2/19ट .सी.-II , दनांक 14 माच, 2019 का संल नक

( प - I)
उ र दे श सरकार
कायालय का नाम...........................................................

आिथक प से कमजोर वग के सद य ारा तुत कया जाने वाला आय एवं प रस पित माण-प

माण-प सं या-........................... दनांक-..................................

व ीय वष ............................. के िलए मा य
मा णत कया जाता है क ी/ ीमती/कुमार .....................................................

पु /पित/पु ी ............................................... ाम/क बा...........................................................

पो ट ऑ फस ..................................................... थाना ..............................................

तहसील ................................ जला ............................................ रा य ....................................

पन कोड............................. के थायी िनवासी है , जनका फोटो ाफ नीचे अिभ मा णत है , आिथक प से

कमजोर वग के सद य ह, य क व ीय वष ......................... म इनके प रवार क कुल वा षक आय 8

लाख (आठ लाख पये मा ) से कम है । इनके प रवार के वािम व म िन निल खत म से कोई भी प रस प

नह ं है ः-

I. 5 (पाँच) एकड़ कृ ष यो य भूिम अथवा इससे ऊपर ।

II. एक हजार वग फ ट अथवा इससे अिधक े फल का लैट।
III. अिधसूिचत नगरपािलका के अंतगत 100 वग गज अथवा इससे अिधक का आवासीय
भूख ड।
IV. अिधसूिचत नगरपािलका से इतर 200 वग गज अथवा इससे अिधक का आवासीय
भूख ड।
2. ी/ ीमती/कुमार ..................................................... जाित ........................... के

सद य ह, जो अनुसूिचत जाित, अनुसूिचत जनजाित तथा अ य पछड़े वग के प म अिधसूिचत नह ं है ।

ह ता र ........ (कायालय का मु हर स हत)

पूरा नाम ...........................................

आवेद क का पासपोट साईज का

पदनाम .............................................
अिभ मा णत फाटो ाफ

जलािधकार /अित र जलािधकार /िसट

मज े ट/परगना म ज े ट/तहसीलदार।
 4

कायालय- ाप सं या-3/2019/4/1/2002/का-2/19ट .सी.-II , दनांक 14 माच, 2019 का संल नक

( प - II)
आिथक प से कमजोर वग के लाभाथ वंय घोषणा प
वंय घोषणा प
म ............................................ पु /पु ी/प ी ...............................................
ाम/क बा .................................................................. पो ट ऑ फस ......................................
थाना .................................. लाक ................................. तहसील ................................
जला ............................................ रा य .................................... ने आिथक प से कमजोर वग के
माण प हेतु आवेदन दया है , एत ारा घोषणा करता/करती हू ँ :-
1. म ................................... जाित से स ब ध रखता/रखती हू ,ँ जो उ र दे श हे तु
अिधसूिचत अनुसूिचत जाित, अनुसूिचत जनजाित एवं अ य पछड़ा वग क सूची म सू चीब नह ं है ।
2. मेरे प रवार क कुल ोत (वेतन, कृ ष, यवसाय, पेशा इ या द) से कुल वा षक आय
....................................... (श द म) है ।
3. मेरे प रवार के पास उ ल खत आय के िसवाय अथवा इसके अित र अ य कोई
प रस प नह ं है ।
अथवा
कई थान पर थत प रस पितय को जोड़ने के प ात भी म (नाम) ............................ आिथक
प से कमजोर वग के दायरे म आता/आती हू ँ।
4. म घोषणा करता/करती हू ँ क मेरे प रवार क सभी प रस प य को जोड़ने के प ात ्
िन निल खत म से कसी भी सीमा से अिधक नह ं है -
I. 5 (पाँच) एकड़ कृ ष यो य भूि म अथवा इससे ऊपर ।
II. एक हजार वग फ ट अथवा इससे अिधक े फल का लैट।
III. अिधसूिचत नगरपािलका के अंतगत 100 वग गज अथवा इससे अिधक का आवासीय
भूख ड।
IV. अिधसूिचत नगरपािलका से इतर 200 वग गज अथवा इससे अिधक का आवासीय भूख ड।
म मा णत करता/करती हू ँ क मेरे ारा उपरो जानकार मेरे ान और व ास के अनुसार स य है
और म आिथक प से कमजोर वग के िलए आर ण सु वधा ा करने हे तु पा ता धारण करता/करती हू ँ । य द
मेरे ारा द गई जानकार अस य/गलत पायी जाती है तो म पूण प म जानता हू /
ँ जानती हू ँ क इस
आवेदन प के आधार पर दये गये माण प के ारा शै णक सं थान म िलया गया वेश/लोक से वाओं एवं
पद म ा क गई िनयु िनर त कर द जायेगी/कर दया जायेगा अथवा इस माण प के आधार पर कोई
अ य सु वधा/लाभ ा कया गया है उससे भी वंिचत कया जा सकेगा और इस स ब ध म विध एवं िनयम
के अधीन मेरे व क जाने वाली कायवाह के िलए म उ रदायी रहू ँगा/रहू ँ गी।
नोट:- जो लागू नह ं हो उसे काट द।

आवेदक/आवे दका का ह ता र तथा पूरा नाम।

थान :-

दनांक :-