Govt. P.G. College Bilaspur H.P.

STUDENT ADMISSION FORM

Session 2023-24
Student Detail

Student ID: 22081653 Please affix your passport

size photograph here
Name Sakshi

Email ID: sandhyarsakshi@gmail.com

Programme: M.Sc. in Mathematics-with-M.Sc. Mathematics

Semester / year 4th Sem

Session 2023-24

Admission Date: Aug. 19, 2022, 4:54 p.m.

University Roll No. 77222740019 College Roll No. 22M.SC. MATHS017

Parents / Guardian Info

Father’s Name (As per matric certificate) Rajender kumar Father occupation Private employee

Mother’s Name (As per matric certificate) Rekha Devi Mother occupation House wife

Father’s Mobile no.(mandatory) 9805644358 Whats App No.

Guardian/Parent Mobile no. Guardian Relation

Personal Profile

Gender Female Date of Birth July 26, 2002

Nationality Indian Mobile No. 9805644358

Programme (UGC CBCS) Details

Nature of Course Course Title

Core Main(DSC-1)
Magneto Fluid Dynamics (M405)

Complex Analysis-II (M401)

Differential Geometry (M404)

Advanced Discrete Mathematics (M403)

Functional Analysis (M402)

Categories As Per Roster

Admission Category SC Religion Hindu

Blood Group O+ Marital Status Single

Aadhar Card No. 351827597890 Sports No

 IRDP No NSS Yes

NCC No Cultural No

Single Girl Child No Physically handicapped / (PH) Disabled (with percentage) No

HP Bonafide Yes Gap after 12th No

Address

Permanent Address Correspondence Address

Vill Nalag Tehsil Sadar Vill Nalag Tehsil Sadar

City Barmana District Bilaspur City Barmana District Bilaspur

State Himachal Pradesh Pin Code 174013 State Himachal Pradesh Pin Code 174013

Academic Records / Documents

Exam Session Roll No. Name of Maximum Marks Percentage Subject Name of
Passed University Marks Obtained Offered School /
/ Board College of
study

Matric 2017 1711018023 HPBOSE 700 518 74.00 As Per Govt Sr Sec
General School,Barmana
Stream

10+2 2019 1941018050 HPBOSE 500 374 74.80 NON- Govt Sr Sec
MEDICAL School,Barmana

GRADUATION 2022 2190180337 HP 2400 1809 75.38 B.Sc.

University

DOCUMENTS UPLOADED DIGITALLY

Matric Certificate Yes

10+2 Certificate: Yes

Graduation Certificate Yes

NSS Certificate: Yes

HP-Bonafide Certificate: Yes

Admit Card /Mark sheet: Yes

Have you given Entrance Exam ? Yes No

Entrance Exam Roll No : 11074 Entrance Exam Marks : 28
 Anti Ragging Declaration

I promise that I will not indulge in Ragging or any form of violent behaviour. Neither will I tolerate being
ragged or subjected to violence. I understand that if I am accused of Ragging, the responsibility is on me to
prove that I am not guilty.

म वादा करता/करती हूँ िक म रै गग या िकसी भी कार के हसक यवहार म शािमल नह होऊँगा/होऊँगी। न ही म रै गग या हसा का शकार होना बदा त
क ँ गा/क ँ गी। म समझता/समझती हूं िक अगर मुझ पर रै गग का आरोप लगाया जाता है, तो यह सािबत करने क ज मेदारी मेरी है िक म दोषी नह हू।ं
 UNDERTAKING
Note: Online admission is provisional subject to physical verification of the original documents. If any
discrepancy found/ false information furnished by the candidate then his / her admission will stand cancelled
and fee deposited will not be refunded. Further it is certified that:
i) All the particulars stated above are correct.
ii) I am applying for the admission with the consent of my Parents/Guardian who promises to pay my college
dues regularly.

iii) I will not take part in any political, anti-social and anti-national activities.

iv) I will not indulge in any act of ragging, indiscipline and violence and that if found guilty of such offences I
will have no claim against the order of my rustication/expulsion /suspension from the College/University.

v) I will be regular in my attendance and will complete 75% of lectures delivered, failing which I shall not be
entitled to take university examination.

vi) I will appear in house examination and fulfill the condition of eligibility. Any punishment to which my
son/daughter/ ward shall be liable if found guilty of ragging, will be acceptable to me.

Signature of Parent/Guardian Signature of the Student

VERIFICATION

This is to be verified that the contents of this affidavit are true to the best of my knowledge and no part of
the affidavit is
false and nothing has been cancealed or misstated therein. Verified at (Place) .................................... on this
the (day)
...................................... of (month) ......................................, year.

To be countersigned by the Principal/Convener of the concerned Signature of

Committee. Deponent
 FOR USE OF ADMISSION COMMITTEE
Certified that the application is in the order and the following attested copies of required certificates,
enclosed herewith, have been scrutinized.
1. Character certificate from institution last attended (In Case of fresh candidate & in case of gap after
10+2 character certificate issued by Gram Panchayat Pardhan / Tehsildar / Class one Gazetted
Officer) (In case of fresh candidates only).
2. Matriculation Certificate showing date of birth.
3. 10+2 certificate /Eligibility certificate, if required.
4. Migration certificate, if required.
5. Board Equivalence certificate
6. Enrolment form new admission
7. Attendance cum result card
8. Aadhaar card
9. Category certificate
10. Bonafide Himachali certificate (if applicable)
11. Sports / Cultural / EWS / PWD / OBC & other certificate (if applicable)
12. Last year / semester admit card (in case of roll on admission)
13. PTA Membership form
14. PTA General House Meeting form
15. Undertaking by the parents / guardians (Annexure –II)
Note: Original migration certificate will be required at the time of filing the university registration forms.

Enclosures/Entries verified
Member of admission committee Convener(Admission Committee)
(1) Verified by : radhegcblp (2) Approved by : radhegcblp __________________________

(For Use of Scrutiny Committee)

Recommended for admission Admit

Signature of Senior member of Committee

Principal

(For Office use only)

Fee received vide receipt no : ________ Date : ________

Signature of Dealing clerk

 PARENTS - TEACHER’S ASSOCIATION
Govt. P.G. College Bilaspur H.P. Please affix
SESSION 2023-24 parent/guardian
passport size
MEMBERSHIP FORM
photograph
here

1.Name of the Member:

______________________________________________________________________________
(Student’s Father/Mother/Guardian)

2.Address____________________________________________________________________________________

______________________________________________________________________________________________

_______________________________________________________________Mob.No._________________________

Name of Wards Studying in the college:

Sr.No. Neme of Ward Class

Signature of Parent
Father/Mother/Guardian

Membership: The Parents/Guardian of all the students studying in Govt. P.G. College Bilaspur H.P. the
teachers and head of the institution will be members of the association. Whereas Parents/Guardian means
Father-Mother/Step Parents/ Guardian passport Size photograph Father-Mother/Real Grand Father-Mother/Real
Elder Brother Sister of who do not study in the college/Real Brother-Sister of the Father-Mother who looks after
the student in case none of the parents is alive.
 Govt. P.G. College Bilaspur H.P.
ATTENDANCE-CUM RESULT CARD

Name ..................................................... Roll No ............................... Class................................

Session 2023-24

S.N. Subject Total Marks Marks Obt. Passed Failed Lecture

Atten Deli
dancevered

Date COE Govt. P.G. College Bilaspur H.P. Principal

Govt. P.G. College Bilaspur H.P.

PTA GENERAL HOUSE MEETING
Dear parents/guardian

The General House meeting of PTA of our college for the session 2023-24 will be held on
__________ at ___________ in the college.You are requested to make convenient to attend the meeting. With regards.

Yours sincerely
Dated.........................
Principal
 ANNEXURE -II
UNDERTAKING BY PARENTS/GUARDIAN

1) I, Mrs./Mr./Ms. ....................................... (full name of parent/guardian) Father/Mother/Guardian of, (full

name of student

......................................(admission/registration No. ..............................), having been admitted to Class

..................,

Sem/Year ........... have received a copy of the UGC Regulations on Curbing the Menace of Ragging in Higher
Educational
institutions ; 2009, (herein after called the "Regulations"), carefully read and fully understood the provisions
contained in the said regulations.

2) I have, in particular, per used clause 3 of the Regulations and am aware as to what constitutes ragging.

3) I have also, in particular, per used clause 7 and clause 9.1 of the Regulations and am fully aware of the
penal and administrative action that is liable to be taken against my ward in case he/she is found guilty of or
abetting ragging, actively or passively, or being part of a conspiracy to promote ragging.

4) I hereby solemnly undertake that-a) My ward will not indulge in any behavior of act that may be
constituted as ragging under clause 3 of the regulations.
-b) My ward will not participate in or abet or propagate through any act of commission or omission that may
be constituted as ragging under clause 3 of the regulations.

5) I hereby affirm that, if found guilty of ragging, my ward is liable for punishment according to clause 9.1 of
the Regulations, without prejudice to any other criminal action that may be taken against my ward under any
penal law or any law for the time being in force.

6) I hereby declare that my ward has not been expelled or debarred from admission in any institution in the
country on account of being found guilty of, abetting or being part of a conspiracy to promote, ragging and
further affirm that, in case that declaration is found to be untrue, the admission of my ward is liable to be
cancelled.

Signature of deponent

Date ........................ Name .....................................................

Place ....................... Address .....................................................

..............................................................

Tel. No./Mob. No..............................................

VERIFICATION
This is to be verified that the contents of this affidavit are true to the best of my knowledge and no part of
the affidavit is false and nothing has been
cancealed or misstated therein. Verified at (Place) .................................... on this the (day)
...................................... of
(month) ......................................, year.
To be countersigned by the Principal/Convener of the concerned Signature of
Committee. Deponent