Jnanabharathi, Bangalore – 560 056, Karnataka State
Application fee paid details
Affix Recent Passport size Photo of the Candidate
D.D. No. : ………………………………………… Date of Issue : ………………………………………… Bank : …………………………………………
Application to Integrated B.Sc-M.Sc. and BMS-MMS Course of Bangalore University, for the year 2016-17
Photocopies of relevant certificates should be submitted for all your claims All the fields should be filled. Fields not applicable should be written as N.A Incomplete application is liable to be rejected Candidates who have completed Two Year PUC/equivalent are eligible to apply for the following courses Course : Integrated B.Sc-M.Sc., Biological Sciences
Regular seat
BMS-MMS (Management Studies)
Payment seat
Note: Candidates seeking admission for more than one course shall apply separately for each course
1. Candidate’s Name
Initials
2. Nationality: Indian
Foreigner
3. Gender: Male
Female D
D
M
M
Y
Y
Transgender Y
4. Date of Birth:
Y
Age (as on 1st July 2016)
Note: Only Candidates below 22 years as on 1st July 2015 are eligible for Integrated Courses
5. Mother’s Name
Occupation
Father’s Name
Occupation
Guardian’s Name
Occupation
6. Are you the only girl child of your parents? Yes If yes, enclose an affidavit from competent authority 7. Category Online Scholarship (post metric) Regn. No. (for SC/ST candidates only)
No
Online Scholarship Reg. No. (Backward class welfare department) Rs.
8. Fathers/ Mothers Annual Income
9. Do you belong to Below Poverty Line (BPL) Yes
No
10. Have your studied 7 years in Karnataka?
No
Yes
11. SSLC Register No. 12. Aadhaar Card No.
Others
13. Address for correspondence City State Pin Code Telephone E-mail ID 14. Are you a Kashmiri migrant?
Mobile No. Yes
No
15. Have you studied in Rural area upto 10th Std? Yes 16. Have you studied in Kannada medium upto 10th Std?
No Yes
No
17. Are you Son/Daughter of Bangalore University Employee? Teaching Non-Teaching 18. Mention whether you claim any of the following quota Sports Cultural NCC ‘C’ certificate
NSS Defense Physically challenged
19. Details of the qualifying examination a) Qualifying examination
d) Institution last attended ____________________________________________________ e) Overall percentage ____________________________________________________ f) Class – I/ II/ III
g) Max Marks ______________________ Marks obtained _________________________ h) Optionals studied at PUC or Equivalent: Science
Commerce
Arts
Languages
Max. Marks
Marks scored
Optionals
Max. Marks
Marks scored
Total 20. Have you studied Biology in higher secondary (10+2)? Yes 21. Have you studied Mathematics in higher secondary (10+2)? Yes 22. Have you already obtained UG/ PG Degree or studying any UG/ PG
Yes No
No No
If yes _________________________ give details _________________________
23. Do you need Hostel facility, if you are selected for University Departments? Yes
No
If yes, what is the distance to B’lore from your native place
24. Any other information you would like to furnish
25. Total number of enclosures Declaration by the candidate I hereby declare that the above information furnished by me is true; I have not hidden any information. Bangalore University can initiate action against me, if I have furnished any wrong information. Date: Place:
Signature of the Applicant Signature of the Parent/ Guardian
ACKNOWLEDGEMENT
Received the Application of Sri/Smt …………………………………………………………………........ ……………………………………………………………………………………………………………………………... for Application No. being ……………………………… for ………………………………………………... ……………………………………………………………….. course at Bangalore University. Date : ________________________________________
Signature& Seal of the Receiving Officer
Remarks on the enclosures
The Acknowledgement form may be used as Hall -ticket to gain entry into Counseling Centre / Entrance Test
FOR OFFICE USE ONLY Supernumerary weightage Details
Weightage
Awardee name
Signature
Date
Sports Cultural NCC ‘C’ NSS Defense Physically challenged Details to be verified by the concerned Department Sl. No.
Particulars
01
SSLC Marks Card Photocopy enclosed
Yes
No
Resister No.:
02
PUC Marks Card Photocopy enclosed
Yes
No
Resister No.:
03
Year of passing the Qualifying examination
04
Caste certificate Photocopy enclosed
05
Parents income certificate enclosed Yes No (as on after 1/4/2012) – 5 years valid
06
Photocopy of Aadhar card enclosed
07
Online Scholarship (Post Metric) Registration Number enclosed
Yes
No
08
Whether the candidate has applied for any supernumerary seats (sl. No. 14 to 18)
Yes
No
09
Whether the candidate has applied for payment seats
Yes
No
Yes
Yes
Signature of the verifying official
No
No
If yes, which category If yes, parents/ guardians annual income ____________
Online Scholarship (post metric) Regn. ... Application to Integrated B.Sc-M.Sc. and BMS-MMS Course of Bangalore University, for the year ... NCC 'C' certificate.
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