Sr. No. .. Received on Signature of receiver .

Last date for receipt of application Form : (i) all Courses except (ii) below : 4-7-2011 (ii) M.Phil./Certificate/Diploma Courses : 22-7-2011

PANJAB UNIVERSITY, CHANDIGARH

Application form for Admission for All Courses (except for Ist Year Classes of the courses where admission is based on AIEEE & CET as the admission of these courses will be conducted online). for P.U. Chandigarh and its Regional Centres at Hoshiarpur, Ludhiana, Kauni and Muktsar Session 2011-2012 Panjab University Registration No./PUPIN (If any) 1.Name of the department :__________________________________________________ 2. Class:_____________________ 4.Name of the Candidate 5.Fathers Name 6. Mothers Name 7. Guardians Name 8. Annual Income from all sources Rs. 9. Date of Birth 12 Address for Correspondence . 10. Sex [M/F] 11. Nationality 3.Category code (see instructions)

Affix recent Photograph of 3.5 cm. X 4.5.cm. duly attested by the Head of the Institution last attended

Pin Code 13.Parmanent Address.

Tel No.

Pin Code 14. Are you claming weightage on any of the following (Tick if Yes )

Tel No.

N.S.S. Cultural activities Youth welfare Passing last examination from P.U. N.C.C. 15.Are you employed? Yes /No 16 Are you applying for hostel accommodation ? Yes /No 17 Are you enrolled in or seeking admission to any course concurrently ? (If yes, give details) Yes /No 18 Did you take admission in any of the departments of the Panjab University during the last three years? Yes/No Year Deptt. Roll No. Result If so, give year, department, roll number and the (i) .. result of the university examination, if appeared. (ii) .. (iii).. 19. Entrance Test Roll No. and Course Under which you appeared Roll No.CourseMarks

1. 2. 3. 4. 5. 6. 7. 8.

.. (Full Signature of the Candidate) DECLARATION BY THE APPLICANT AND THE PARENTS/GUARDIAN I declare that I have carefully read the instructions and state that the entries made by me in this form are correct to the best of my knowledge and nothing has been concealed. I understand that my admission is liable to be cancelled if any of the statements made by me above is found incorrect. I undertake to observe proper standards of academic conduct. I shall abide by the prescribed courses of reading and the modes of examinations, which may prevail from time to time, even though these may be at variance with those of the previous years. I shall abide by the rules and regulations as given in the Panjab University Calendars and its revisions/Handbook of Information and rules for Admission. I shall faithfully carry out the instructions issued by the Chairpersons of the Department, Faculty members and other University Authorities from time to time. I hold myself for due and prompt payment of fees and all other dues. I understand that I cannot concurrently be enrolled for more than one full-time courses of studies. I am fully aware that ragging is strictly prohibited/punishable under Law in the University. If I am found guilty of indulging in or abetting ragging, I shall be liable for punishment and expulsion from the Hostel/University.

Dated : ..

. (Full Signature of the Candidate) I certify that my son/daughter/ward is making this application with my permission. I hold myself responsible for his/her good conduct and behaviour as a student of the University and for payment all his/her fees and dues during his/her stay in the Department. .. (Full Signature of the Parent/Guardian) Name: Address:

Dated : ..

CERTIFICATE FROM THE EMPLOYER

In case the applicant is in some Private Organisation, the certificate shall be countersigned/attested by a Gazetted Officer I certify that Mr./Miss/Mrs.s/o,d/o,w/o .. has been working as in our organization for the last years .. months.. days. He/She has obtained our permission to join the said course. His/her emoluments are Rs. per month. Signature of the Employer Name and Designation (Seal of the Office)

ATTESTED

Dated .. Place ..

Signature & (Seal of attesting Authority) CERTIFICATE OF EMPLOYMENT (Deptt. of Evening Studies)

I certify that I _____________________________ s/o,d/o,w/o _____________________________________ has been working as _______________________________ in Govt./Semi-Govt./Private Organisation/Self employed* for the last _________________ years. *Strike off whichever is not applicable ____________________________ Signature of the Employer Name & Designation (with seal) SUMMARY OF EDUCATIONAL QUALIFICATIONS FROM Xth Class ONWARDS (Attested Photostat/Xerox copies of detailed Marks Certificates and Degrees, etc., must be attested in support of statements)
Previous Exam. Passed Name of Exam/Class Subjects studied Max. Marks Marks obtd. %age Session & Year Roll No. Uni./ Board Name of School/College

______________________ (Signature of the Candidate)

Aggreagate of All University Examinations held during the B. Pharm. Course (attach details separately) and valid GATE-Score if apeared. Please also give here reasons for any break in your educational career.

(Signature of the applicant) (CHECK-LIST OF DOCUMENTS ATTACHED (TO BE FILLED IN BY THE CANDIDATE) University Certificates (List all the copies of certificates separately and make sure that the Detalied Marks Certificates of the examination on the basis of which admission is sought are included. (i) (ii) (iii) (iv) (v) (vi) Total number of documents attached

Note : Incomplete application form or with wrong or deliberately concealed information is liable to be straight away rejected.

INSTRUCTIONS FOR CANDIDATES

1. 2. 3. This form must be filled in by the candidate in his or her own hand in a clear and legible manner. This application form complete in all respects must be submitted to the concerned Teaching Department/Centre of the Panjab University as has been indicated in the Admission Notice of 2011-12 as well as in Handbook of Information and Rules for Admission 2011 on or before the last date indicated at the top of application form, even if, result of the qualifying /Entrance examination has not been declared. The application form must be completed in all respects. No column should be left unfilled. If any information sought is not applicable to the candidate, the word N.A. should be entered against this column. If a candidate omits/conceals relevant information or gives false information, his/her admission is liable to be cancelled. All documents like copies of University Certificates, photographs, certificates claiming special status, etc. must be attached with this application. In case the required documents are not attached, the application is liable to be rejected as incomplete. The forms in which various certificates are to be submitted are given in the Handbook of Information. Only certificates along these lines will be acceptable. Handbook of Information and Rules for admission 2011 can be obtained in cash (Rs. 500/-) at the Post Offices at Chandigarh: (Sector-14, 15, 17, 20, 36 & 47), Hoshiarpur: Near District Court, Ludhiana: Bharat Nagar Chowk, Muktsar: Head Post Office, Manimajra: SCO 294-95, Motor Market, Mohali: Sector 55, & Panchkula: Sector 8 & by Post (Rs. 600/-) from the Manager, Publication Bureau, P.U., Chandigarh-160014 against account payee Bank Draft drawn in favour of the Registrar, P.U., payable at Chandigarh. All copies of University Certificates, photographs and character certificate, etc., must be attested by the Head of the Dept. last attended or by a Class I Gazetted Officer or by an Officer of the University not below the rank of Assistant Registrar/Lecturer. The full name of the attesting officer and the official seal must be clearly legible on the certificate. The check-list of documents printed on this form should be carefully filled and the total number of documents enclosed with the application should be clearly mentioned. Foreign students should submit this Form to the concerned department through the office of the Dean of International Students, Panjab University. For filling item 3 of the form use the following codes. ( One can fill more than one category):Category Code Category Code General GN Wards of Military/Paramilitary Personnel died in action D1 Scheduled Caste SC Wards of Military/ Paramilitary Personnel incapacitated while in service D2 Scheduled Tribe ST Wards of Military/ Paramilitary Personnel Ex-Servicemen D3 Backward Classes BC Defence Personnel incapacitated while in service D4 *Sports Person SP Wards of Serving Defence Personnel D5 Physically Handicapped/ PH Ex-Servicemen D6 VH/Blind Terrorist Victims TV Serving Defence Personnel D7 Freedom fighter FF Foreign Nationals/NRI NI Kashmiri Migrant KM Single Girl child SG *Candidates seeking admission to a course under reserved category of sports should submit an additional photocopy of the complete admission form alongwith self attested photocopies of sports certificates, class X, class XII D.M.C. showing the date of birth & original photograph to the Chairperson/Director of the concerned Department/Centre/Cell, Panjab University, Chandigarh-160014 and are required to appear for trial in a proper sports kit along with their original sports certificates on University Grounds as per schedule i.e. 08.07.2011 to 09.07.2011. Presence of candidate in the field at appointed time is mandatory. No separate intimation will be sent. NOTES : 1. 2. 3. 4.

4. 5.

6.

7. 8. 9.

THE CANDIDATES SHOULD UNDERSTAND THAT THE ADMISSION IF GRANTED BY THE DEPARTMENT/CENTRE WOULD BE PROVISIONAL AND SUBJECT TO CONFIRMATION BY THE DEAN OF UNIVERSITY INSTRUCTION. FEES/FUNDS AND CHARGES PAYABLE FOR VARIOUS COURSES BY THE STUDENTS SHALL BE AS PRESCRIBED BY THE SYNDICATE OF THE PANJAB UNIVERSITY, CHANDIGARH FROM TIME TO TIME. HOSTEL SEATS ARE LIMITED AND THESE WILL BE ALLOTTED EXCLUSIVELY ON THE MERIT BASIS AS PER THE QUOTA ALLOTED TO THE DEPARTMENTS. AT THE TIME OF ADMISSION, THE STUDENTS SHOULD SUBMIT AN UNDERTAKING THAT HE/SHE HAS NO CRIMINAL BACKGROUND AND HAS NOT BEEN CONVICTED UNDER ANY CRIMINAL OFFENCE. HE/SHE SHOULD ALSO STATE IN THE UNDERTAKING THAT NO F.I.R. IS REGISTERED AGAINST HIM/HER OR NO CRIMINAL PROCEEDINGS ARE PENDING AGAINST HIM/HER AT THE TIME OF SUBMISSION OF APPLICATION. FURTHER, THE STUDENTS SHOULD ALSO STATE IN THE UNDERTAKING THAT HE/SHE WILL NOT POSSESS/CARRY ANY LETHAL WEAPON ON THE UNIVERSITY CAMPUS AND IF ANY WEAPON IS RECOVERED FROM HIM/HER, HE/SHE BE RUSTICATED. (Syndicate Para 6 dated 29.3.2011)

In addition to attested copies of academic certificates, the candidate should also attach attested copies of the documents/certificates listed below:(a) Certificates relevant to claim for a Reserved Category Seat Each applicant applying for admission in sports category shall, along with application, submit an affidavit, duly attested by a Notary, regarding his/her achievements in sports on a stamp paper of Rs. 3/(b) Character Certificate. (c) No Objection Certificate from the Employer (d) Migration Certificate (e) Affidavit of or about not having been involved in any offence (required in case of a gap in academic career). (f) Eligibility certificate. (g) Certificate in support of claim for weightage/weightages (h) Foreign Nationals/NRI candidates are required to submit relevant certificates .

P.U.P. (15) 2500/17-05-2011