RAJIV GANDHI PROUDYOGIKI VISHWAVIDYALAYA

Selt sigd &

BHOPAL- 462036 Attested passpoit s74
Photograph from the
TO
The Register
ENROLLMENT FORM Head ot the
1stitutions with sea
Rajiv Gandhi Proudyogik
Vishawavidyalaya, Bhopal
Sir
Gvng he ollowing details, I
request you to
Communicated m2 the alotled Erolinont Nuriber please
Enrol me in the
Rajv Gandni Proudyogiki
omse to abid
i have reäd
a the rules, Vishawavidyalàyà. öhopa
Ieguidlions anu oF0nanace of the University relevant to
by themalse prommse 0 obay all rules and ma i

regulaton enforced h
1. (a) Name (ln capital Letters)
Mt/Ms

HHIHH
(as Per 10+2 Mark sheeU
passing certificate)

(b) Name of Student in Hindi.. (Sumame) (First Name) (Middle Name)

*********'*********** ************* ***
********************************************
(c) Gender
Male
2. Female
(9 Name of father..
*********** ************************** *** ******
(i) Name of mother.. ************************************** ***************

**** *********** ********** *****

****************** ************ ********* *********** ********
3 ************
Date of Bith
Date
Month Month Year
. ) Category

i) Religon.. *
Gen OBc OBC SC sT Other Class
L
***.***
******************************
********************************************** ***************************
5. Date of Admission
Date Month Year

6. Name of the College/lnstitute

being admitted.
College code_
7. Name of the Board/Univesity Class
Already Passed Board/University Passing Year Marks Obtained
10+2
********* ******** ************** ************************************* *************
JEE Maks
********************************* ************************************* **********************"*
Other ****** ******* ************ ***************************************
********* **

8. Name of the course in which admitted

9. Mode of admission: (JEE/AIEEE/Others)..*******.*** ******

***********'*************************'******* *******
*******~******************
10. Name of the Board/University last attended with year.. * .

***************
***************"******************* *********** ******* * *

11. Migration Certificate No. If any (attach in Original).* * * ****** * ** ******** *************** ******************

12. Permanent Postal Address **************** ** ******* ** ************************** ****~***. s . ..... ***

... MODle........... STD

*"******~***"*********************** . .
ei No. (with Code): ******** ************ ****************

Date...
CERTIFICATE Signature.* * *
Certified that the above student has been admitted to this Institution
the entnes above has been
through procedure as laid down by the Govt. of Madhya Pradesh and
checked and verified by me from records. Therefore I recom.mend that he/she
should be enrolled as requested
by the student.

Date..... ********"
Signature of the Head of the Institution with seal