PAL COLLEGE
OF TECHNOLOGY & MANAGEMENT
Sr. No. _______
One Recent self -
AFFILIATED TO KUMAON UNIVERSITY, NAINITAL attested
Passport size
Photograph to
be pasted here
ADMISSION FORM
Course Name:
1. Candidate’s Full Name ( in block letters - as per 10th mark sheet )*
2. Mother’s Full Name ( in block letters )*
3. Father’s Full Name ( in block letters )*
4. Date of birth ( as per x certificate )*
5. Nationality* 6. Religion*
7. Category(Tick)* UR SC ST OBC EWS
8. Aadhaar No.*
9. Present Address ( in block letters)*
Village/ Town / City District
Pin State
10. Local Guardian Name Relation
Mobile No.
11. Permanent Address ( in block letters)*
Village/ Town / City District
Pin State
12. Mobile No. Father* 13. E -Mail ID
14. Mobile No. Mother* 15. Mobile No. Student*
16. Particulars of Examination Passed*
Examination Passed Board / Counsil / University/Other Year Of Passing Division/CGPA % Of Marks In Aggregate* Subject
12TH
10TH
OTHERS
ANY OTHER EXAM
FOR OFFICE USE ONLY
17. Direct Registration From University ( KU / UOU ) Yes ( ) No ( )
Registration Number_________________________________ Date___________
18. Eligible For Scholarship Yes ( ) No ( )
19. Scholarship Applicable I_____________ II_____________ III_____________
20. Scholarship Amount I_____________ II_____________ III_____________
Total Scholarship Amount:_________________________
21. Document Submitted Yes ( ) No ( )
Signature Of Counsellor
Name____________
DECLARATION BY THE APPLICANT
I hereby declare that all the information provided in this form is true and accurate to the best of my
knowledge. If any entry is found to be false or misleading, my admission shall be automatically
canceled, and I shall be liable for any action deemed appropriate by the College/University.
I also declare that I will submit myself to the disciplinary jurisdiction of the University and the Principal of
the College. I acknowledge that my admission and continuation as a student are subject to the
provisions of the University's Statutes, Ordinances, Rules, and Instructions issued from time to time.
I further undertake to abide by the rules of discipline and proper conduct as prescribed by the University
and College authorities.
PLace______________ Full Signature Of the Candidate
Date_______________
DECLARATION BY THE PARENT/GUARDIAN
I have carefully reviewed the statement and information provided in the application form by my ward,
whose photograph appears on this form, and I confirm that all details are true and accurate.
I hereby declare that I take full responsibility for my ward’s regular attendance, conduct, and behavior
during his/her tenure at the College.
PLace______________ Full Signature Of the Parent/ Guardian
Date_______________
