Application Form 2014-15 Complete application form along with necessary documents and fees as required should be sent to the University address by Speed Post/ Registered Post only. For additional information, kindly contact us at email: [email protected] or Call at 1800 180 4181. Affix Recent Passport Size Color Photograph (TO BE FILLED IN BLOCK LETTERS) COURSE APPLIED FOR: _____________________________________________________________________ NAME OF CANDIDATE _________________________________________________________________________ DATE OF BIRTH ________________________________ GENDER Male Female CONTACT No: LANDLINE _________________________ MOBILE: ______________________________________ E-MAIL: ______________________________________ CATEGORY: GEN OBC SC & ST PLACE OF BIRTH ____________________________________ FATHER’S NAME______________________________________________________________________________ MOTHER’S NAME _____________________________________________________________________________ PARENT’S Contact No: LANDLINE (with Area Code) _____________________MOBILE: _____________________ PARENT’S EMAIL (In block letters): ________________________________________________________________ PERMANENT ADDRESS ________________________________________________________________________ ___________________________________________________________________________________________ ____________________________________________________ PIN ___________________________________ COREESPONDENCE ADDRESS ___________________________________________________________________ ___________________________________________________________________________________________ ____________________________________________________ PIN ___________________________________ LOCAL GUARDIAN NAME (If any) ________________________________________________________________ ADDRESS ___________________________________________________________________________________ ___________________________________________________________________________________________ CONTACT No: LANDLINE _________________________ MOBILE: ______________________________________ HOSTEL FACILITY REQUIRED: Yes No ACADEMIC RECORDS Class Subject Marks/Grade Percentage Board/University Year of Passing X XII Graduation Post Graduation Others PAYMENT DETAILS: Demand Draft of Rs 10,000/- as Registration Fee (Non-Refundable but Adjustable in Course Fee) & Rs 800/- as cost of Application Form (Non-Refundable) should be enclosed with the Application. The DD must be drawn in favor of “ Himgiri Zee University” payable at Dehradun. Amount: Rs____________________ Bank & Place: ____________________________ DD No._________________________ Date: __________________________________ DECLARATION I hereby declare that all the particulars stated in this application form are true to the best of my knowledge and belief. I have read and understood all provisions of admissions and agree to abide by them. In the event of submission of fraudulent, incorrect or untrue information or suppression or distortion of any fact like education qualification, marks, nationality, etc., I understand that my admission/degree is liable for cancellation. I further understand that my admission is purely provisional subject to the verification of the eligibility conditions. I am also aware of the financial obligation of applying to and studying at this University and I undertake to pay the tuition and other fee and to abide by all rules and regulations of the University. Registration Fee once paid will not be refunded. I undertake to deposit the entire course fee for the session 2014-15 (One Year) before the commencement of classes. Signature of the applicant: ____________________________________ Date: ________________________ Signature of parent/guardian: __________________________________ Date: ________________________ DOCUMENTS TO BE ENCLOSED (Photocopy) 1) 2) 3) 4) 5) 6) 7) 8) 9) Application fee of Rs. 800/- & Registration fee of Rs 10,000/- in the form of a bank draft in favor of 'Himgiri Zee University' payable at Dehradun. Self Attested copy of the marks/ grade sheet/transcript of the qualifying examination. Original Transfer Certificate, Migration Certificate & Character Certificate. (At the time of admission) Birth certificate or 10th standard mark sheet showing date of birth. Passport size photograph (recent). Photocopies of Identity Proof Photocopies of Address Proof Photocopies of Caste Certificate (In case of OBC, SC & ST) Photocopies of Resident/Domicile Certificate Contact us: Himgiri Zee University, P.O. - Sherpur, Chakrata Road, Dehradun, Pin - 248197, Uttarakhand, India. Tel. : 0135 2102676, 2110005 Toll Free Number 1800 180 4181 Please Visit us at www.hzu.edu.in Enquiry: [email protected]
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