NITLM e ADMISSION FORM niversi os ty Form No. Receipt No. Course applying for : Academie Session. i Allis Personal Details mieten ‘Name (in Block Letter) Please put your name atthe back Date of Birth ld mm yyyy Place of Birth. of photograph Gender [~] Male Female Nationality Domicile of Haryana ["] Yes. [_] No Category sc ST oBc General Language(s) Known, Telephone No, (with STD Code) Mobile No. E-mail ID. Permanent Address City. Siate Pin omespondence Address City. State Pin Father’s Name Father’s Occupation Mother's Name. Mother’s Occupation Family Income (Monthly) Academic Qualifications Qualification! Year of Passing] Name ofthe Institution | BoarWUniversty | Sueam/Degree | Subject'Specializaion| Pereentage Masters Graduation 12th 10th Details of Work Experience (if any) Years, Months Name of Organization Designation Held Nature of Responsibility Duration — | No, of YearsExtra Curricular Activities / Awards / Achievements: Sports Culturals How did you come to know about NIILM University? (Please specify) [J Advertisement [[] Ontine [] Family & Friend [] Coaching instiute [] Others please specify) Accommodation Required [_] Yes [] No Have you appeared for any State Level/National Level exam like AIEEE/CAT/MAT/Others (Please Specify) Applicant Checklist Complete Application Fom — [] Transfer/ Migration Crticate [] Domicile Cenficate [_] Caste Cette Altested Pholocopy of Nth, XMth & Graduation Mark Sheet [] Photocopy of Prout [| AIEEEICATIMAT/Other Examinstion Scorecard (available) Prospectus fee of Rs, 600/- to be submitted in favour of “NIILM University” by Demand Draft'Cash Dated of, (Bank) Payble at Kaithal ‘Terms & Conditions a Admission 1. Theadmission ofa canidat stands cael itis fund hat heh has submit fase documents, ras made clams subison nish selon res. 2. Neuve taken dean esenbl care in obtaining the University satus Fon the Government of Haren and Unversity Grants Commision (UGC), However we shal be ‘ena yan cane inthe ws goverment policy ud ligating is status sacha il be oily in sch am event. 3. Theaimision ete, prospects, nfrmaion cha and website ofthe Unters are the erect and only guide tothe temas and conden of wisn andthe ules nd segaation fhe Univesity, Stade ae dvi oe othe same for crifcaton No oer form of sommuicton th than thse mentioned, whet write © verbal is there betwen he Universit and he stuens 44, Exc forthe sexy noe ofthe emponens fhe es nee us refndable ner ay canst. 5. NIILM University eserves its night fo eves fe strc as and when recommended bythe management. 6 The Universi reseres the ight io cancel the aso of ay candidat under any ofthe allowing ccunsianes 8) Ifthe fess isnot deposi by the plated dat ') uke candidates does oon the paicularprogranune by the ited date eve though ie Fee has besa deste, 6) Ifthe canes asus the prof ofthe minima lige qualification requ for admission int the programm couse within the plated timeframe 4) hese indulge in Raging Actives. 7c fund indulging in dug lcobol abuse, violence or improper behavior and does no abide by the lesa elton as are relevat rom etme she wl temsicatd. 8. Atv that ve the sont of inerrng with education pursuit of owl, oir evouin of student’ perfmance re robe and offends shal be Tale for propriate pie ation 9 The eons aid herein ae tnding onthe student and hse adison to NIILM University if ow fhser own fe willand consent and at isher on tum tisk 10, Any request fr cacliton of admission andor eta to be made in wtng a month before te classes commencing te reasons fo witha Te action on plication shall b sided bythe Admison Commies based on he mitgatng creunstaness fore reid sought, Normal processing ine wl be ake nth rows. Any disput isareement inthe same hl eee tahiti to be ajuzated upon by sl abiratr being reid Jade of High Cur andthe ame shal be binding nba pares 1. The acceptance of a ofr ofamison implies the conent ofthe student of teres and rations ofthe nies, 12, Incase candidates found o be non-igile orperinming regular dates und any Governmentl/ Noo-Goveramenal department Company witht providing any ‘NOC/Conseat cect fiom concerned deprtment, hse adnisson will sd cancelled at any sage ofthe admission processor comse delivery with immediate fet bythe iver i Slo, the undersigned do hereby declare that I have read and understood the rules and regulations given herein above and the same are acceptable to me, Date : Signature of the ApplicantUNDERTAKING FORM Students/Guardian Have you appeared for any State Level/National Level exam like AIEEE/CAT/MAT/Others (Please Specify) 1d Son/Daughter of having been admitied to NIILM University, have received a copy of the UGC Regulations on Curbing the Institution (Menace of Raging in Higher Education Institution ,(here-in-nftercalled the "Regulations"), carefully read and fully understood the provisions contained in the said Regulations. 2. My wand have particular, pursued clause ofthe regulations and am aware as to what constitutes raging. 3. /My Ward have also, in particular, perused clause and clause. | of the Regulations and am fully aware of the pane! and administrative action that is liable to be token against mine ward in case he/she is found guilty of or abetting raging, activity or passively, orbeing part ofa conspiracy to promote raging. 4. 1 /My ward here by solemnly aver and under take tha a) I/My ward will not indulge in any behavior or act that may be constituted as ragging under clause of the Regulations. b) My ward will not participate in or abet or propagate through any act of commission or omission that ‘may be constituted as ragging underclause ofthe Regulations, S. UMy ward hereby affirm that, if found guilty ofragging, my ward is liable for punishment according to clause . of the regulations, without prejudice to any other criminal action that may be taken against myward under any penal lawor any law for the time being force. 6. I/My ward here by declare that my ward has not been expelled or debarred from admission in any institution in the country on account of being found guilty of, abetting or being part of a conspiracy to promote, raging and further affirm that, In case the declaration is found to be untrue, the admission of my ward is liable to be cancelled. Declarad this (day) of. (month) of, (year) Signature of deponent Name Address: ‘Telephone/Mobile No: VERIFICATION Verified that the contents of under taking ore true to the best of my knowledge and no part ofthe under taking is false and nothing has been concealed or misstated there in Ve ied at (place) on this the ___(day) of (month) of (year) Signature of deponent Name Address