Application No.
____________
Application Form
Instructions:
1. Form should be filled in block capital letters in English language with blue ink only
by the applicant.
2. In complete application will be rejected without any further communication.
3. Filling up of application form does not guarantee the acceptance of request for
evaluation.
(For Office use only)
Enrollment No.: ___________
Enrollment Date: ___________
Course applied for:
Specialization/Stream:
Session:
JAN 20________
Year(pls. check)
Credit Transfer
1/2/3/4
Lateral Entry
JUNE 20_______
(As entered in secondary/ senior secondary certificate)
Name of the Applicant:
Gender:
Male
Female
Date of birth
Others
DD
\\
MM
Fathers Name:
YY
Please affix passport
size photograph here
Mothers Name:
Nationality:
Indian
Others
(specify the name of the
country):_________________________
Social Status:
General
SC
ST
OBC
Physically handicapped
Minority Community
Employment: Govt. Employee
Permanent Address:
Pvt. Employee
Self Employed
Mailing Address:
(Signature)
Unemployed
Pin Code: City/District:
Pin Code: City/District:
State:
State:
Contact No.
Contact No.
e-mail:
e-mail:
(any change in address should be immediately communicate to NCIS)
Have you ever been Debarred by any University/ Board? No
If yes, then attach the details of the same
Yes
Others
Academic Details (enclose duly attested true photocopies of the originals)
S.No
Name of
Year of
Name of University/
Percentage
Subjects
Examination
Passing
Institution/ Board
1.
Secondary
2.
Sr. Secondary
3.
Graduation
4.
Post-Graduation
5.
Others
S.No.
Work experience details (Furnish latest three details)
Name and Address of the organization
Total Experience In
Years
Declaration by the Applicant
I hereby declare that aforementioned information and enclosed documents above are true and complete
to the best of my knowledge and belief. I have read and understood the rules, regulation and eligibility
conditions of the Institute. I shall submit any other document(s) that may be required by the university in
future. I also agree that the Institute is empowered to cancel my candidature / admission, forgo the fee
deposited and also the claim for admission, if any information furnished by me is found to be incorrect,
misleading or counterfeited. I further declare that the attested photocopies of the certificates submitted by
me at the time of admission are the true copies of the originals.
Place& Date
Signature of the Applicant
Declaration by the Applicant in case of Credit Transfer/ Lateral Entry
I hereby declare that I have already completed the formalities for ...........year(s) of............................
(Course titled), from.......................... And agree to appear in ........................year(s) of examinations and
also previous years mismatched paper, if any.
Place& Date
Signature of the Applicant
Declaration by the SKP Administrative Head
I hereby declare that aforementioned information and enclosed documents have been filled and enclosed
in my presence and are true to the best of my knowledge and belief. I have read and understood the rules,
regulation and eligibility conditions of the University. I also agree that the University is empowered to
cancel this candidature / admission, forgo the fee deposited and also the claim for admission, if any
information furnished above is found to be incorrect, misleading or counterfeited. I further declare that the
attested photocopies of the certificates submitted by the student at the time of admission are the true
copies of the originals.
Place& Date
Seal of SKP and Signature of the Administrative Head
