Form No.

: …………
(For Office Use Only)

SINGHANIA UNIVERSITY
(Established U/S 2(f) of UGC Act 1956)
Narnaul-Singhana-Pilani Road, Pacheri Bari, Distt. Jhunjhunu (Raj.) - 333515, Phone No.: 01593-271005, 271331
Fax No.: 01593-271003, Tele/Fax: 01593-271070, Mobile: 09352237951/52/53, website: www.singhaniauniversity.co.in

Admission Application Form Session 2010-2011

Course: -------------------------------------------------------------------
Self attested
Department: -------------------------------------------------------------- Photo
1. Name : ………………………………………………………………………………………
2. Father’s/Husband/s Name: ………………………………………………………………………………………………………………
3. Date of Birth: ……………………………………………………………………………………………………………………………………
4. Present Address: ……………………………………………………………………………………………………………………………….
(in block letters) ………………………………………………………………………………………………………………………………..
5. Phone No.: …………………………………….. Mobile: …………………………………. Email: ……………………………………
6. Correspondence Address: …………………………………………………………………………………………………………………
…………………………………………………………………………………………………………… PIN ……………………………………..
7. Category : General/SC/ST/OBC …………………………………………Annual Income-------------------
8. Gender : Male/Female ………………………………………………………
9. Qualifications :
Exam Year of Board/University % Subjects Photo copy
Passing attached
Secondary
Sr. Secondary
Graduation
P.G.
Others

10. Course Fee: As per university rules (please see website).

11. (A)Fee deposition Detail
Amount of fee Bank name Account no.
----------------------- ------------------- -------------------

Deposition date mode of payment challan/DD/Cheque number

----------------------- -------------------------- -------------------

(B) Hostel Facility: Separately for boys and girls. Fee Rs. 36,000/- per annum plus Rs.
2,000/- refundable security.
 Amount of fee Bank name Account no.
-------------------- ---------------- --------------------

Deposition date mode of payment challan/DD/Cheque number

---------------------- ------------------------- ------------------------------------

12 Uniform measurement (A)-Shirt size -------------- -------------- --------------------

(B)Trouser Size --------------- ---------------- ---------------------

© Blazer Size --------------- ----------------- ----------------------

13 Interested Sports/Games (Please mention here) -----------------------------------------------------------------------

DECLARATION

I……………………….Son/Daughter/wife of …………………………solemnly declare and affirm that I am duly

qualified to take admission in the course for which I have applied and all the certificates and
testimonials attached with my application are true and valid. I have fully satisfied myself about the legal
status of the University i.e. it is an autonomous statutory body with regulations making power for it’s
functioning. University is duly authorized and competent to take my admission in the course for which I
have applied. I also undertake not to ever raise any objection about Universities legal status to take my
admission and award degrees on qualifying prescribed examinations. I also undertake not to demand
refund of fee/charges paid by me. In case of any dispute/differences/claim or disciplinary action
settlement by University arbitration clause shall be applicable.

I shall always follow the rules and regulations of the University and in case of any breach thereto, I shall
be liable to be penalized for the same which may include expulsion from the University.

Place: (Signature of Candidate)