Purnea University, Purnea (Bihar)

Under-Graduate (UG) Admission Application Form

SESSION 2024-2028

UAN# 24G000042231 Appl. Date:04-05-2024 11:08 AM

1. Candidate Name: MD MERAJ ALAM

2. Father Name: MD HARUN RASHID
3. Mother Name: AFROJA KHATUN
4. Date of Birth: 15-05-2001 5. Gender: Male
Physically
6. Category: EBC 7. Not Applicable
Handicapped:
8. AADHAAR: 696165830266
9. Domicile: Bihar 10. Dom. Cert
11. Religion Muslim 12. Minority No
13. Nationality Indian 14. EWS Status No
Acknowledgement
15.
No
16.Address for Correspondence: 17.Permanent Address
BALDIYAGACHHI-POST-TELTA-PS-BALRAMPUR BALDIYAGACHHI-POST-TELTA-PS-BALRAMPUR
DIST-KATIHAR- DIST-KATIHAR-
Katihar Katihar
Bihar Bihar
854317 854317

18. Mobile 6296858921 19. Email mdmerajalam1158@gmail.com

20. Payment Details Paid Rs 600.00 on 04-05-2024 Ref#11000217857497

21.Qualification
Examination Board/University Year Roll No. Max Mark obt. Mark Percentage
Bihar School Examination
10th 03-2022 14334-2200030 500 225 45.00
Board(BSEB)
Bihar School Examination
12th 03-2024 94195-24030036 500 293 58.60
Board(BSEB)
Subjects/Stream:BA
Subject Obtained Marks Max Marks Percentage%
Hindi 60 100 60.00
Urdu 53 100 53.00
History 59 100 59.00
Geography 55 100 55.00
Psychology 66 100 66.00
22.College/Major Course Chosen
Prefernce# District College Degree Subject
1 Kishanganj Marwari College, Kishanganj BA Urdu (Major) Urdu
2 Katihar RDS COLLEGE, SALMARI BA Urdu (Major) Urdu
3 Katihar Balrampur College, Balrampur BA Urdu (Major) Urdu
4 Katihar B. .D. College, Barsoi BA Urdu (Major) Urdu

Declaration
I declare that i have never been convicted for any criminal act and that there is no case pending against me in the court of law.I also declare that i
have never been caught using Unfair Means or any Disciplinary action has been taken against me.if i was charged for using Unfair Means,the
punitive duration is over and charges have been cleared.I have read carefully and have understood all rules as mentioned in the University Rules
and Admission Brochure.Furthermore i also declare that if my application is found to contain incorrect/false information regarding my Name,Birth
Date,Gender,Relligion,Domicile,Weightage,Caste,Horizontal Reservation,Marks obtained or any other field,my application is liable to get
cancelled,and I will have no objection in getting disqualified for admission to the concerned course/college.

Full Signature of the Aplicant

Options checked during Application

Document Checklist
Note: Mark the number of documents (Photocopy/Xerox) attached by the candidate during form submission to the college.

Xth Marksheet Xth Certificate

XIIth Marksheet Last Exam Passed Marksheet
Recent Pssport Size Photograph Scanned Signature
Domicile (for other state) Certificate for Kashmiri Resident
Certificate for Category Certificate for Sub-Category
Document for Claiming Weightage Other Certificate/Document

Download Date :04-05-2024 11:08 AM