Admission Cum Registration Form Course applying for B.VOC.- MLT 3 year (six semesters)Amount (Rs) Fees payable at the admission/registration time (Minimum 37,500) In the favour of Dogra Paramedical Gurukul and Arogya Kendra payable at HoshiarpurDD Number DateDay12345678910111213141516171819202122232425262728293031Month123456789101112Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Bank Name Personal InformationName of the applicant* Upload Recent ImageMax. file size: 512 MB.Father’s Name* Mother’s Name Date of Birth*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920CategorySelectGenBCSCSTHandicappedBlood GroupSelectO-O+A-A+B-B+AB-AB+ReligionSelectHinduSikhMuslimChristianGender* Male Female Married Yes No Area Rural Urban Permanent Address (For all communication the college)Address City/Village* Post Office Tehsil District* State Pincode Email Address* Aadhaar (UID) No Personal Mobile Number* Father’s Mobile Number* Any Other Mobile Category Information (Only for students willing to avail any scholarship)Father’s Occupation Annual Income Aadhaar Number Mother’s Occupation Annual Income Aadhaar Number Bank DetailsBank Name Branch IFSC Code Branch Address Account Number Category Certificate DetailsCertificate No. Issue DateDay12345678910111213141516171819202122232425262728293031Month123456789101112Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Issuing Authority Other InformationHave you ever been expelled/rusticated/punished on account of using unfair means in exams/misconduct/indiscipline by any school, college or university, or convicted of any criminal case or otherwise of a violation of any law? Yes No Do you require Hostel Facility? Yes No Do you require Bus Facility? Yes No Do you require Parking Facility? Yes No Qualification Details Summary of Academic Information (Fill whichever is applicable) Exam Passed 10th +2 Year of PassingYear of Passing 10th Year of Passing +2 Board/Uni.Name of Board/Uni. 10th Name of Board/University +2 School/CollegeName of School/College 10th Name of School/College +2 Total MarksTotal Marks Obtained 10th Total Marks Obtained +2 Remarks/ResultRemarks/Result Status 10th Remarks/Result Status +2 Awards / Achievements (if any) Distinguishment in any games Gap in studiesYesNoNo. of years Reason for Gap Consent* I hereby agree that I will deposit the following:*1. Twenty passport size color photographs. 2. 10th certificate/ Mark sheet (for proof of DOB) – original & attested photocopy 3. 10+2/Graduation/Diploma Mark sheet and certificate – original & attested photocopy (whenever I receive) 4. Migration certificate – original & attested photocopy (when I received) 5. Attested photocopy of Aadhaar card (student’s / Father’s / Mother’s) 6. Caste / category / Low income certificates – original & attested photocopy (only for students applying for a scholarship if required) 7. First semester total fees according to course payable at admission time DECLARATIONDECLARATION BY THE APPLICANT / STUDENTHEREBY DECLARE I wish to take admission Guidance / Coaching in the ANNIKET VIDYAPEETH V.P.O- NANGAL BIHALAN. DISTT-HOSHIARPUR, PUNJAB in the above mention course:- 1. That I have read the rules governing my provisional admission in ANNIKET VIDYAPEETH at VPO – NANGAL BIHALAN, DISTT- HOSHIARPUR. 2. That I have fulfilled the application form after thoroughly understanding ther rules and the information filled by me in the application form is correct and true to the best of my knowledge and belief. 3. That I have never been convicted by any court and not been debarred or disqualified by any board / university from appearing in any examination. 4. That I shall not indulge in any form of ragging or any in disciplinary activities and shall strictly abide by the code of conduct. 5. I am fully aware of prevailing rules regarding fulfillment the criteria of 75% attendance for my eligibility to apply and appear in the Examination. 6. That fees once deposited under any head will not be refunded. 7. That all matters subject to jurisdiction of HOSHIARPUR CITY ONLY. Further, I declare that I have taken admission in the above mention course with my fee wish and Without any pressure. I will be responsible for all information given by me. I have confirm about Reorganization / affiliation of course & legal status of institution and I have no course to any one on this ground i.e. will not claim this ground and I have taken admission in this course only for Knowledge & wisdom. lnspite this AANIKET VIDYAPEETH not given any assurance of GOVT.JOB I, also declare that will maintain complete discipline during my study at the institute . I further declare that I will not demand any refund after the admission. It is certified that my Parents/ Guardian have allowed me to seek admission to the above course and I will pay dues of the ANNIKET VIDYAPEETH regularly and in time. Further I know very well that Aaniket Vidyapeeth do not give any kind of verbal or non verbal assurance of Pvt. Or non private Govt or non Govt placement visa assurance evaluation positive credential assessment employment or higher education in India or abroad.Signature of Student Signature of Guardian Undertaking by the Parents/ guardians of Applicant I have read through the above mention particular and allow my son/ daughter to join the course in the AANIKET VIDYAPEETH and herby agree to pay the installment of fees board examination fees etc. and when demand by the institute or by any authorized person I certified that my son/ daughter has submitted this application with my knowledge consent.Complete Address Date DD slash MM slash YYYY Signature of Parents/Guardian*
