Dated: 19-12-2022 01:17:36 Form No.

: 22011

S.S. JAIN SUBODH P.G. (AUTONOMOUS) COLLEGE, JAIPUR

[Affiliated to the University of Rajasthan, Jaipur]
B.SC. (PASS COURSE)
Re-Admission Form for Second Year (Session 2022-23)
Institution S.S. JAIN SUBODH P.G. (AUTONOMOUS) COLLEGE, JAIPUR

Course B.SC. MATHS Semester (s) III and IV

Roll No. 2031504 Enroll. No. 19/001862

Applicant's Name MUKESH SINGH LODHI

Mother's Name SUNITA DEVI

Father's Name MOHAR SINGH LODHI

Date of Birth 06-Apr-2003 Gender MALE

Category OBC Adhar No. null

Mobile (Applicant) 9887433586, (Parent/Guardian)

e-Mail Address mohar4741@gmail.com

Address PLOT NO. S - 4 SHANTI NAGAR HASANPURA JAIPUR RAJASTHAN PIN CODE 302006

Subject/Papers COMPULSORY,CHEMISTRY,MATHEMATICS,PHYSICS

Declaration by the Applicant

I MUKESH SINGH LODHI S/o MOHAR SINGH LODHI Solemnly affirm and declare oath that –
1. All the information given in the form are correct to the best of my knowledge and belief.
2. I understand to remain in the College as a disciplined student and abide by the orders issued from time to time by authorities of the College.
3. I have not been found guilty of any unfair practice in the Board/College/University Examination.
4. In the event of any change in Statutes /Ordinance / Rules/Regulations/ Syllabi and Books made by amending or remarking. I shall, except inso far as the College
determines otherwise, comply with the change(s) that apply to the year of study which I have not completed at the timeof change.
5. I am not joining two degree programme in regular mode simultaneously.
6. If I happen to accept any remunerative job during the course of my study. I will inform the department immediately.
7. I have not been convicted of any criminal offence nor have I been released on bail in connection with a criminal case.
8. No case of criminal offence or moral turpitude is pending against in a court of Law.
9. No complaint or F.I.R. has been lodged against me by the College/HOD or by any other competent Authority.
10. I have not restored to an act of indiscipline during the previous year.
11. If I don’t satisfy the eligibility rules of admission and if any information given by me is found to be false, my admission shall stand cancelled.
12. If I don’t Complete the attendance as per requirements of the College. I shall not be allowed to appear as regular candidate in the College Examination.
13. If I damage College Property in addition to the disciplinary action. I or my Parents/Guardians shall have to compensate for the damageincurred.
14. If I am found involved in incident of ragging, I agree to abide by the decision of the College Authorities or their representative in the matter
asper directives of the Hon’ble Supreme Court and other regulatory institutions.
Note: Your re-admission will be provisional subject to clear qualifying examination or direction of
the State Government/University. (Signature of the applicant)

Payment Details
Receipt No. 223120883 Payment Date 22-Dec-2022

Fee Type ANNUAL FEE Payment Mode online

Transaction ID 2911193986 Transaction Date 20-Dec-2022

Fee Amount 18000/- (EIGHTEEN THOUSAND Only.)

Remark: RELAXATION