GURU NANAK DEV ENGINEERING COLLEGE
BIDAR – 585 403. (Karnataka)
(Affiliated to Visvesvaraya Technological University and Approved by AICTE)
Accredited By National Board of Accreditation (NBA)
Application for Admission to First year / Second year (Lateral Entry)
Of Four year Degree Course in Engineering
Reg. No……………………….
(To be filled in by the office)
Affix Recent
Passport Size
Photograph
College Roll No………………
(To be filled in the office)
A-PERSONAL INFORMATION OF CANDIDATE
1. Name of the Applicant (in block letters)
as given in the qualifying examination
certificate. Surname should be underlined
2. Permanent Home Address & Tel. No. With STD CODE
3 Present address for Correspondence & Telephone
No. (Inform the Principal immediately of any
change in the Address & Telephone No.)
4. Date of Birth
5. Nationality of the Candidate
6. Identification Marks
7. Sex
Male/Female
8. Religion
9. Caste
10. Do you belong to SC/ST/OBC
(A certificate as a proof is essential)
11 Marital Status
12. Languages known
13. Hobbies & Extra Co-Curricular Activities
(Give Proof)
Married/Unmarried
(a)
(b)
(c)
(d)
B-Personal Information of Parent/Guardian
1. Father's Name
2. Mother's Name
a) Name:
b) Relationship:
3. Guardian (if parents are not alive)
4. Address of Parent Guardian and Telephone
No. if any
a) Father:
b) Mother:
5. Educational Qualification of Parents
6. Occupation of Parent with Designation
7. Annual Income of Parent/Guardian from all
sources
C-Documents of Candidate
1. Documents to be submitted by Candidate
a) Admission from duly filled in
(
)
b) 10+2 Marks Statement
(
)
c) Date of birth (Matriculation Certificate)
(
)
d) Transfer/Leaving Certificate
(
)
e) Migration Certificate
(
)
f) Religion Certificate (For Sikh)
(
)
g) Any Other (Specify)
(
)
2. To which state do you belong (in case you
belong to Karnataka State Produce Domicile
Certificate by an Officer of the Rank of Deputy
Commissioner)
D-EDUCATIONAL RECORD : 1) Details regarding qualifying examination
Name of
No. of
Duration of
Exam
Name of the College
the Univ.
Attempts
Course
Passed
/Board
Made
Year of
Passing
Reg. No.
2. Have you passed English in the qualifying examination Yes/No
3. Details of Marks in qualifying examination
a) (To be Filled by Candidate Passing 10+2)
Subject
i) PHYSICS
ii) MATHEMATICS
iii) Any one of Following
CHEMISTRY BIOLOGY
BIO-TECHNOLOGY
COMPUTER SC.
ELECTRONICS
TOTAL:
Marks Secured
Maximum Marks
%age of Marks scored
(upto 2-decimal digits)
b) To be filled by Diploma Pass Candidate
Marks obtained in Diploma
IIIrd year
Max. Marks of
Diploma IIIrd year
Percentage Aggregate of Marks
Scored
DIPLOMA IN ……
……………………
TOTAL
6. Branch of Engineering desired in order of preference (the branch will be allotted at the discretion of the Chairman
subject to availability. No change will be permitted later at any stage)
1)
2)
3)
4)
5)
E-Medical Details of Candidate (To be billed in by the parents)
1. In case of Emergency whom to Contact
a) Name
b) Telephone No. with STD Code
2. Blood Group of Candidate
3. Allergy to any Medicine
4. Past Medical History of Candidate (To be
filled in by the Parents)
Information provided by you will be the basis of providing further Medical treatment to your ward please write your ward's
complete Medical History for our records.
STUDENTS IN THE HABIT OF SMOKING CONSUMING LIQUOR OR UN-AUTHORISED DRUGS NEED NOT APPLY
Office Note
1. Receipt No. & Date of Sale of
Application Form
Signature of the Parent/Guardian
(To be filled by the Office)
R. No………….Date:………Rs………
2. Date of Receipt of the Complete
Application Form
3. Student has Passed/Not Passed in the
Qualifying Examinations
4. Whether Admitted
5. Fees Paid
Amount
Receipt No.
Signature
Eligible / Not Eligible
Yes/No
Date
Signature of Dealing official
6. College Roll Number Allotted
7. Branch Allotted
Signature of Dealing Official
1)
2)
3)
4)
5)
6)
7)
8)
9)
10)
11)
12)
13)
AFFIRMATION OF CANDIDATES
I do hereby certify that the particulars furnished above are correct.
I hereby agree, if admitted, to abide by the Rules & Regulations of the College in force from time to time
including the dress code as given in the prospectus.
I undertake that I will do nothing inside and outside the College that will interfere with the orderly
management and discipline.
I will do nothing which will bring a bad name to the College or the management in any way.
I will not consume liquor or drugs (not prescribed by the Doctor) in the Hostel or College, I shall not smoke
in the College and Hostel premises.
I will not indulge in any ragging activities during my course of study in the College. If found guilty
the management can expel me from the College.
I will not interfere in the policy matters of the management relating to administrative affairs during
my course of studies in the College.
I shall treat the Attendance in the morning assembly/period meant for Students activates Co-Ordination
committee / Sports / Any function / activities organized by the College as part of my curricular activities and
will attend the same.
I further agree to submit to any action may entail cancellation of admission rustication / expulsion and/or
criminal prosecution (if necessary as per law)
I fully understand that above action may entail cancellation of admission rustication / expulsion and/or
criminal prosecution (if necessary as per law)
I fully understand that I have been given admission as Sikh student under minority quota and that in case, I
fail to maintain the Sikh status I am liable to disciplinary action of expulsion / confiscation of security deposit
from the College (Sikh Students).
I understand that Branch of Engineering Allotted by Management will be final.
I have read and understood the above clauses and hereby append my signature by my own free will.
Date:
Signature of the Candidate
Place:
AFFIRMATION OF PARENT / GUARDIAN
1) I certify that the above particulars furnished by my son / ward are correct.
2) I undertake to educate my son/ward in this college till completion of the course.
3) I undertake the responsibility of timely payment of all college dues of my son/ward and for his good conduct
throughout his stay in the college. In case of failure to do so the Management's decision will be final and binding
on me.
4) I understand that failure to clear the College dues before University Examination my ward will not be permitted
to appear in the examination.
5) In case I withdraw my son/ward in the middle of the course, I agree to pay remaining year fees compensation
stipulated by the management of the College.
6) I understand that the admission once taken is final and amounts paid shall not be refunded under any
circumstances.
7) I understand that in case of false / suppressed information my son/ward is likely to be expelled from college in
addition to criminal prosecution if required.
8) I understand that my ward shall be expelled/rusticated if found consuming liquor, or un-authorized drugs or
smoking.
9) I have fully understood the consequences of the above undertaking and hereby append my signature by my own
free will.
10) Any legal dispute will be subject to Bidar Jurisdiction.
Date:
Place
Signature of the Parent/Guardian