HIMACHAL PRADESH UNIVERSITY, SHIMLA -171005.

APPLICATION FORM FOR ENTRANCE TEST FOR ADMISSION TO B.Tech

(Civil,CSE,IT,Electrical,ECE)1ST YEAR COURSE FOR THE SESSION 2023-2024

1. Name of the Course : B.Tech (Civil,CSE,IT,Electrical,ECE) Reg. No. : 742923744

2. Name : HIMANI

3. Father's Name : baldev parkash

4. Mother's Name : manju angaria

5. Examination Center for Entrance Test : DHARAMSHALA

6. Address for Correspondence (IN CAPITAL LETTERS) :

V.P.O ARLA TEHSIL PALAMPUR DISTRICT KANGRA,H.P.

7. Mobile No. 9418291605

8. Permanent Home Address (IN CAPITAL LETTERS) :

V.P.O ARLA TEHSIL PALAMPUR DISTRICT KANGRA,H.P.

9. Telephone No.

10. Email-Id : himani85804@gmail.com 11 Aadhaar No. : 616469666403

.

12. Date of Birth : 31 Jul 2005 Age as on 1st July of this year : 18 yrs. 0 Months

13. High School Marksheet No.: 7260112

14. Nationality : Indian 15. Sex : Female

16. Are you Bonafide resident of Himachal Pradesh? : Yes

17. Are you a Single girl child ?: No 18. Are you physically challenged?: No

19. Are you Ward of HPU Employee? : No 20. Do you belong to J&K Domicile? : No

21. 12 School Located in : HP

22. Board of 12 Exam : Other

23. Your Category : General

24. Details of Fee Deposited Amount : Rs. Dated : 15/05/2023

1000.00

25. Academic Qualifications :

Result
26. Examination Name of the Passing Credits/Marks Maximum Marks Credits/ Exam Roll
Status Passed Board/University Year Obtained (not for the % Marks No.
candidate with
CGPA)
Passed Matric or ICSE 2021 858.00 1000.00 85.80 7260112
Equivalent
Passed +2 or its ISC 2023 335.00 500.00 67.00 7260112
Equivalent

26. Were you ever disqualified/suspended by the University or any other institution from No
attending classes or appearing in any exam ? If yes, give Details :

Details :

Declaration by the Candidate

I hereby declare that the entries made by me above are correct to the best of my knowledge. I am conscious that if any of
the entries are found to be incorrect, my admission is liable to be cancelled. I have read carefully the Handbook of
Information and I undertake to abide by the rules of the University. I have gone through the rules and regulations of the
University and I hereby solemnly affirm that I will not indulge in any kind of ragging/ indiscipline and if I am found guilty of
any offenses, I will have no claim against the order of the rustication/ expulsion / Cancellation of my admission from the
University .I further undertake that in the event of my ineligibility at the time of counseling / admission, I shall have no
claim for admission and as such my candidature is liable to be cancelled for which I am solely responsible.

Date : Signature of the Candidate