MUHS Examination Form

To, Examination Form No. :

The Controller of Examinations, College Code :
MUHS, Nashik. 3313
UG PG
Fresh Repeater
Sir, Please (√) Mark

I request permission to present myself at the ensuing -------- Examination to be held

in -------- half of -------- I furnish my details as stated below:-
1. CANDIDATE’S NAME in Capital Letters (Strictly as per Class XII or GAZETTE Notification):

2. MOTHER’S FIRST NAME in Capital Letters :

3. FATHER’S/HUSBAND FIRST NAME in Capital Letters :

4. Candidate’s address in CAPITAL Letters only :

PinCode:

5. State: Contact No. :

6. College Name: Ashvin Rural Ayurved College

7. Email Address:

8. Gender: Male Female

9. Date of Birth :

Paste (do not staple

recent Photograph Paste (do not staple)
(Size 35mm× 45mm) recent
Left Hand Thumb Impression
duly attested by the Photograph (size
Dean/Principal/Head of 35mm× 45mm)
the Institution.
must not be larger
Photograph must not
than this box.
be larger than this box.
ATTESTED
UN-ATTESTED
Signature of Candidate in running hand, within the box only

NOTE: It is to be ensured that this Photograph and Signature should match with the Photograph and Signature of Hall ticket
10. List of Documents/Items to be attached / verified:
Sr. Documents Attached For College For MUHS
Particulars
No. Yes/No Use only Use only
1. Photograph duly attested by the Dean/Principal ---------
2. Photocopy of marks statement of latest examination ---------
Photocopy of Eligibility letter (For First year Students only) OR Transfer letter ---------
3. (If Applicable)
FOR PG STUDENTS, following document is also to be submitted:

4. Attendance Cert. of Research Methodology workshop (for Fresh students)

5. Log book (for Fresh students)

6. UG Degree certificate of respective University

NOTE: Incomplete Examination form and without documents will be rejected by the University.
 MUHS Examination Form

11. Dress Code:

Sr. No Particulars Yes/ No*
Whether candidate want to wear Cultural/Traditional dress during the university examinations. [If yes, it
1 is mandatory to remain present at examination center before 01 hour of commencement of university ---------
examinations for proper frisking (Checking)]

I will be appearing for the following Subjects (for Subject Name and Subject Code, please refer Theory Time-Table
published by the University on the website)
Sr. Subject Subject Name For Fresh Students Only
No Codes Attendance % HOD Name HOD Sign
Theory Practical
1 -------- -------------
2 -------- -------------
3 -------- -------------
4 -------- -------------
5 -------- -------------
6 -------- -------------
7 -------- -------------
8 -------- -------------
9 -------- -------------
10 -------- -------------
DECLARATION BY THE CANDIDATE
1) I am aware that, I have to fulfill criteria of attendance and Internal Assessment prescribed by the University
upto commencement of Examination, failing which I shall be held “NOT ELIGIBLE” and will not be allowed to
appear for Examination.
2) I hereby declare that I have not availed of any attempt (including the present one) in excess of the maximum
attempts permissible by Central Council / University for the said examination (wherever applicable).
3) I hereby declare that I have gone through the syllabus prescribed and relevant rules of Ordinance 1/2014
(amended) Heads of Passing which are applicable for the examination for which I am appearing and I accept
the same without any challenge (wherever applicable). Reference Ordinance 1/2014 rule 59, 60 & 62 for head
of passing and Grace Marks) OR as applicable from time to time.
4) I shall be responsible if my application form is rejected for any errors, wrong or incomplete entries made by
me in the examination form.
5) I hereby declare that I shall not claim any concession on religious ground.
6) I am not defying the criteria of the admission order.
7) I am not admitted to the course after the cut-off date declared by the University for Grant of terms.

Place:

Date: / / Signature of Candidate in running hand

CERTIFIED BY THE HEAD OF INSTITUTION

I certify that,
Shri/Smt/Kum.

is a bonafide student of this college and has satisfactorily attended the classes and
1. that his/her attendance is not less than as prescribed by the University & respective council norms in lecture teaching and
practical work, however, in case prescribed attendance is not fulfill upto commencement of examination, Hall ticket of the
Candidate will be marked as “NOT ELIGIBLE” against the respective subject.
2. that the candidate has completed the academic terms and appeared in mandatory number of internal assessment tests as
per the university rules (wherever applicable).
3. that he/she is not admitted to the course after the cut-off date for grant of terms.
4. that the candidate has completed house job (For PG Only– wherever applicable)
5. that the information furnished by the said candidate is verified from his/her documents and that the
candidate is Eligible to appear for University Examination.

Place:

Date: / / Signature & Seal of the Dean/Principal