Application Form
Note Keep payment details ready i.e. Scratch card purchased from College Counter.
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Personal Information
Name of the applicant* (As in Qualifying Examination)
(First Name) (Middle Name) (Last Name)
Date of Birth*
Gender* Male Female
Father's Name* Mother's Name*
Nationality* State of Domicile*
Category*
Please tick on the appropriate boxes. Sportsperson Handicapped Rural        Urban             NRI

Present Address
Address Line 1* Mobile No.
Address Line 2 Telephone No.
Town/City
Note Either Mobile no. or telephone no. is mandatory.
Country*
Email Address*
State*
Confirm Email*
District*
Alternative Email Address
Pincode*

Permanent Address Same as Present Address? Yes No

Permanent Address
Address Line 1* Mobile No.
Address Line 2 Telephone No.
Town/City
Note Either Mobile no. or telephone no. is mandatory.
Country*
Email Address*
State*
Confirm Email*
District*
Alternative Email Address
Pincode*

Guardian Details (If Applicable)
Local Guardian Name Relationship with the Applicant
Address Line 1 Country
Address Line 2 State
Town/City District
Pincode Local Guardian Mobile No.

Upload Your Photo
 
Do you want to upload your photos now?*     Yes  No 
   
Qualifying Examination Details
Qualification Name of Board / University University Regd. No. / Board Roll No. Main Subjects Session Percentage Marks
   
Course Details
Note Applicants cannot apply for more than ONE degree program.

Please select University option*
Punjab Technical University Jalandhar  Punjabi University Patiala 
Baba Farid University of Health Sciences,Faridkot  Guru Ravidas University ,Hoshiarpur 
National Council for Hotel Management and Catering       Technology  Directorate of Technical Education and Industrial       Training,Department of Punjab Courses 

Other Courses
Punjabi University Patiala Registration No(if already Registered).
Accommodation and transport requirement detail
Do you need hostel accommodation?*
    Yes    No   
Do you need transport?*     Yes    No   
   
Payment Procedure
Note If the candidate has payed the fees at the Desh Bhagat College, he/she will be provided with a Scratch Card voucher.
Please enter the Scratch Card Number.
Scratch Card Number*
List of certificate received
1. Matric.
2. 10+2.
3. Migration.
4. Graduation.
5.Character Certificate.
6.Caste Certificate(photocopy).
7.Rural area Certificate(photocopy).
8.Copy of ration card.
9.any other.
Declaration By Student and Parent

 

1. I am responsible for the information given above by me and it is true to the best of my knowledge and belief and nothing has    been concealed therein.
2. I hereby agree to confirm to all rules, acts and laws enforced by the Government and Institute. Further I, hereby undertake that    if I disobey any of the rules or regulations of the institute, then any disciplinary action may be taken against me, even to the     extent of expulsion from the institute.
3. I know that at any stage of my course, if any, discrepancy is found in my testimonials/documents/eligibility by the university or    any other Authority, the institute will not be held responsible and I will own the responsibility.
4. I hereby agree to pay the full fee of course even if I discontinue at any time during the course, as I am fully aware that the seat    vacated by me will be a loss to the institute.
5. I hereby agree to fulfill the 75% attendance condition and to clear the conditional examinations to make myself eligible in the    final exams as per the university rules.
6. I hereby undertake that I will submit all the original certificates of (Matric/+2/Graduation/Migration/Reserve Category) by 16th    Aug,2011.
7. I understand that I had to make payment of fee in Account Office only against proper receipt.
8. I understand that the college authorities have explained me about the eligibility criteria & status of the college regarding Punjab.    Govt. approval,AICTE approval and university affiliation etc.
9. I undertake the entire responsibility of his/her good behaviour and he/she will maintain proper discipline during his/her stay in the    college.
10.I understand that ragging in the college is cognizable of fence as per Supreme Court guidelines. If my ward is found ragging any      other student on the campus he/she can be expelled from the college. The undertaking form has been submitted by me.



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Signature of the Student Signature of the Parent

  
  I Agree.  

   

Version 6.01.03