अभभरर ददरद घघषणद (Declaration By The Applicant)

1. मम एतददरद हवहधवत घघषणद करतद हहह/करतश हहह कक उपभसरकत दश गभश सभश सहचनदएम सतभ हम। तथभय कघ हछपदभद भद गलत तरशकक सक पसतसत नहह ककभद गभद हह। ममनक हववरहणकद मम

पवकश पककभद सममनधश सभश सहचनदएम तरद तथभ पढ हलभक हम तरद मम इनकद अनसपदलन करमगद/करमगश। भकद कक गई पहवहषभय तरद समलगनक पमदण-पतय मम कघई तसरट/हवसमगहत पदई

जदतश हह तघ मकरद पवकश हनरसत कर कदभद जदए। ऐसश हसरहत मम मम शसलक वदपसश कक हलए ककसश भश पकदर कद ददवद नहह करमगद/करमगश।

2. मम भह घघषणद करतद हहह/करतश हहह कक ममनक सभश सव-पमदहणत पपत इस आवकदन पत कक सदर समलगन कर कदभक हम।

3. हवशवहवददलभ ददरद हनरमत हनभमदवलश कक तहत कस लपहत/कस लसहचव अरवद अनभ अहधकक त वभहक ददरद आवशभकतद पडनक पर हनभमदनससदर कक गई ककसश भश पकदर कक

अनसशदसहनक कदभरवदहश मसझक सवशकदभर हघगश।

4. मम सभश हनभमय/हनणरभय और हवहनभमय कद पदलन करमगद/करमगश।

5. उततरदखणड मसकत हवशवहवददलभ कक समसत परशकदएम कक वल उततरदखणड रदजभ मम हश समपनन हयगश।

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.
4. I agree to abide by the rules and regulations.
5. All examinations of Uttarakhand Open University will be conducted only in Uttarakhand State.

सरदन (Place) अभभरर कद नदम (Name of the Applicant)

कदनदमक (Date) अभभरर कक हसतदकर (Signature of the Applicant)

अधभभन कक नन ददरद सतभदपन एवमम अगसदरण पमदण-पत

(Verification and forwarding Certificate by the Study Centre)

मम (समनवभक) एतददरद शश/शशमतश/ससशश (अभभरर कद नदम) Ankit Dhoundiyal

पसत/पसतश/पतनश RAMKRISHNA DHOUNDIYAL जघ इस अधभभन कक नन (कघड सहहत)

14049-Government Degree College, Thalisain (Pauri) मम पदठकम

BA-23-BACHELOR OF ARTS मम नदमदमककत हए हम, कद पवकश आवकदन पत

अगसदररत करतद/करतश हहह। मकरक ददरद इस पवकश फदमर कक समसत पहवहषभय तरद समलगन पमदण -पतय कद महल पमदण-पतय सक हमलदन
कर सतभदहपत कर हलभद गभद हह।
I (Coordinator, Study Centre) hereby forward this admission form of Mr./Mrs./Ms Ankit Dhoundiyal

Son/Daughter/Wife of
RAMKRISHNA DHOUNDIYAL for admission in (Name of Study Programme)
BA-23-BACHELOR OF ARTS
at (Study Centre name/Code)
14049-Government Degree College, Thalisain (Pauri) 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

कदनदमक (Date) अधभभन कक नन समनवभक कक हसतदकर

Sign. Of Coordinator, Study Center
मघहर(Seal)
 Uttarakhand Open University
उतरदखमड मसक हवशहवददलभ
Haldwani,Nainital |हलददनश ,नहनशतदल
By Debit/Credit/Net-Banking Enrollment No. : 25369140
Reginal Center /Study Center Information/Program Fee
Regional Center : 14-Pauri

Study Center : 14049-Government Degree College, Thalisain (Pauri)

Program : BA-23-BACHELOR OF ARTS

Year/Semester : 1-Semester

Course Details: BAHI(N)-101 BAHL(N)-101 BAPS(N)-120 AECC-H-101 BAPS(N)-101

GECOM-02 DMM-101 VAC-09

Exam City: 57-Thailisain Study Medium : Hindi

Admission Fee : 2295.00 Exam Fee : 2500.00
Additional Fee : 150.00 Degree Fee : 0
Late Fee : 0.00
Total Amount : 4,945.00
Basic Information
Name : Ankit Dhoundiyal Gender : Male
Father Name : RAMKRISHNA DHOUNDIYAL Date of Birth : 17-May-2007
Mother Name : GEETA DEVI Name (in hindi) : अमककत ढढहडभदल
Mobile No. : 918439896817 E-Mail : hyper4822@gmail.com
Nationality : Indian
Handicap : N

National Id Name : AADHAR Card National ID No. : 319615502232

Territory : Rural Marital : Unmarried
Cast Category : General Domicile : Uttarakhand
Religion : Hindu
NAD ID: ABC ID: 593820815176
Economic Class: BPL
Livelihood Status: Unemployed
Prison Inmate: N Correspondence Address:
Eligibility Information VILL DOUUND POST DHOUND
Eligibility: 10+2 / Equivalent PAURI
Board/University: UK BOARD Uttarakhand 246275
Year of Passing: 2024 India
Percentage: 59.4
Division: I
Subject: hINDI MATH PHYSICS CHEMSITRY ENGLISH

Application Place : Application Date 8/20/2025 11:46:04 AM

Academic Qualication
Examination Year University Per (%) Division Subject

10TH 2022 UK BOARD 58 I HINDI SANSKRIT MATH SCIENCE

SOCIAL SCIENCE ENGLISH

8/20/2025 11:47:45AM Page 2 of 2