अभभरर ददरद घघषणद (Declaration By The Applicant)
1. मम एतददरद वववधवत घघषणद करतद हहह/करतत हहह कक उपभररकत दत गभत सभत सहचनदएए सतभ हम। तथभथ कघ वछपदभद भद गलत तरतकक सक पसतरत नहह ककभद गभद हह। ममनक
वववरवणकद मम पवकश पककभद सममनधत सभत सहचनदएए तरद तथभ पढ वलभक हम तरद मम इनकद अनरपदलन करएगद/करएगत। भकद कक गई पवववषभथ तरद सएलगनक पमदण-पतथ मम कघई
तरटट/ववसएगवत पदई जदतत हह तघ मकरद पवकश वनरसत कर कदभद जदए। ऐसत वसरवत मम मम शरलक वदपसत कक वलए ककसत भत पकदर कद ददवद नहह करएगद/करएगत।
2. मम भह घघषणद करतद हहह/करतत हहह कक ममनक सभत सव-पमदवणत पपत इस आवकदन पत कक सदर सएलगन कर कदभक हम।
3. ववशवववददलभ ददरद वनरमत वनभमदवलत कक तहत कर लपवत/कर लसवचव अरवद अनभ अवधकक त वभवक ददरद आवशभकतद पडनक पर वनभमदनरसदर कक गई ककसत भत पकदर कक
अनरशदसवनक कदभरवदहत मरझक सवतकदभर हघगत।
4. मम सभत वनभमथ/वनणरभथ और वववनभमथ कद पदलन करएगद/करएगत।
5. उततरदखणड मरकत ववशवववददलभ कक समसत परतकदएए कक वल उततरदखणड रदजभ मम हत समपनन हथगत।
1. “I hereby declare that the particulars stated in this application form are true to the best of my knowledge and belief. I have read the
prospectus and the admission/eligibility requirements as laid down by the University and I shall abide by them. In the event of
suppression or distortion of any fact in my application. My admission will stand cancelled at any point of time. In case my admission is
cancelled by the University due to any reason. I shall have no claim for refund of fee paid by me.
2. I hereby declare that I have attached all the required self-attested documents with this form.
3. Further I declare that I shall submit myself to the disciplinary jurisdiction of the Coordinator of the study centre. The Vice Chancellor
and Other authorities of the University who may be vested with the power to exercise discipline under the Act . The statutes. The
Ordinances framed by the University. In this regard these authorities have the right to take necessary disciplinary action.
5. All examinations of Uttarakhand Open University will be conducted only in Uttarakhand State.
सरदन (Place) अभभरर कद नदम (Name of the Applicant)
कदनदएक (Date) अभभरर कक हसतदकर (Signature of the Applicant)
अधभभन कक नन ददरद सतभदपन एवमम अगसदरण पमदण-पत
मम (समनवभक) एतददरद शत/शतमतत/सरशत (अभभरर कद नदम) ANSHUL CHAUHAN
परत/परतत/पतनत SIYARAM CHAUHAN जघ इस अधभभन कक नन (कघड सवहत)
11112-VSKC Government Degree College, Dakpather मम पदठकम
BA-23-BACHELOR OF ARTS मम नदमदएककत हए हम, कद पवकश आवकदन पत
अगसदटरत करतद/करतत हहह। मकरक ददरद इस पवकश फदमर कक समसत पवववषभथ तरद सएलगन पमदण -पतथ कद महल पमदण-पतथ सक
वमलदन कर सतभदवपत कर वलभद गभद हह।
I (Coordinator, Study Centre) hereby forward this admission form of Mr./Mrs./Ms ANSHUL CHAUHAN
Son/Daughter/Wife of SIYARAM CHAUHAN for admission in (Name of Study Programme)
BA-23-BACHELOR OF ARTS at (Study Centre name/Code)
11112-VSKC Government Degree College, Dakpather All the entries in this form and attached testimonials
have been verified by me after comparing the same with the original documents
सरदन (Place) अधभभन कक नन समनवभक कद नदम
Name of Coordinator, Study Center
अधभभन कक नन समनवभक कक हसतदकर
कदनदएक (Date) Sign. Of Coordinator, Study Center
मघहर(Seal)
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Uttarakhand Open University
उतरदखएड मरक ववशववददलभ
Haldwani,Nainital | हलददनत ,नहनततदल
Regional Center /Study Center Information/Program Fee
Reference No. : AA25C0646440 Enrollment No. : 23310952
Regional Center : 11-Dehradun
Study Center : 11112-VSKC Government Degree College, Dakpather
Programme : BA-23-BACHELOR OF ARTS
Year/Semester : 4-Semester Exam City : Daakpather
Study Medium : English
Course Info : BAHI(N)-202 BAPS(N)-202 BAPY(N)-221 BAEL(N)-202 BASO(N)-221
Fee :
Programme : 0.00 Additional: 0.00 Exam : 1250.00 Degree : 0 Late Fee : 0.00
Basic Information
Name : ANSHUL CHAUHAN Name in Hindi : अएशरल चचहदन
Father Name : SIYARAM CHAUHAN Mother Name : SALLO DEVI
Gender : Male Date of Birth : 12-Feb-2005
Mobile No. : 919458343371 E-Mail : akshaychauh3an47468@gmail.com
National Indentity: AADHAR Card National Identity No. 823337206084
NAD Id : Country name in
Nationality: Indian case of others
State of Domicile: Uttarakhand Category: Scheduled Tribes
Handicap : No If physically
Territory : Rural challenged :
Religion : Hindu Economic Class: BPL
Livelihood Status : Unemployed If livelihood:
Marital : Unmarried
Prison Inmate (Enrolled in an LSC created in a Prison) No
Eligibility:
Board/University:
Year of Passing:
Percentage:
Division:
Subject:
Complete address for obtaining correspondence/study material
LINE JEEVANGARH VIKASNAGAR Uttarakhand 248198 India
Academic Qualification
Examination Year University Per% Division Subject
12 2023 UK 55 2 H,E,H,E,P
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