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Patliputra University, Patna

Under-Graduate (UG) Admission Registration Form


SESSION 2019 - 2020
URN # 19G0064722 Reg. Date : 24 May, 2019 11:37 AM

1. Candidate Name : PIYUSH KUMAR


2. Father's Name : SANJAY KUMAR
3. Mother's Name : GANITA DEVI
4. Date of Birth : 14-Feb-2001 5. Gender : MALE
6. Category : BC-II 7. Sub Category : Not Applicable

8. Other Category : Not Applicable 9. AADHAAR : 367353446895


10. Domicile : Bihar 11. Dom. Cert. :
12. Religion : Hindu 13. Minority : NO
14. Nationality : INDIAN

15. Address for Correspondance : 16. Permanent Address :


THAMHAWAN ATHMALGOLA THAMHAWAN ATHMALGOLA
Patna Patna
Bihar Bihar
PIN Code : 803212 PIN Code : 803211

17. Mobile : 7903962722 18. Email : pk8542124@gmail.com


19. Payment Details: Paid Rs.300.00 on 24/5/2019 Ref# 8489128347 Bank Ref: MAST - 2090029214
20. Qualifications

Examination Board/University Year Roll No. Max. Mrk. Obt. Mrk.

Highschool C.B.S.E. (Central Board of Secondary Edu. 2, Commu... 2016 7164450 500 446
17026180101
Intermediate Bihar School Exam. Board, Sinha Library Road, Patna 2018 500 311
84
Subjects/Stream : Science

Other Qualifications

21. College/Course Chosen (by order of preference)


3 [201] A.N. College, Patna B.Sc. Mathematics (Hon Mathematics
2 [202] A.N.S. College, Barh B.Sc. Mathematics (Hon Mathematics
4 [205] College of Commerce, Arts and Science, Patna B.Sc. Mathematics (Hon Mathematics
1 [216] R.L.S.Y. College, Bakhtiarpur B.Sc. Mathematics (Hon Mathematics
5 [429] S.N.A. Evening College, Barh B.Sc. Mathematics (Hon Mathematics

Declaration

I declare that I have never been convicted for any criminal act and that there is no case pending
against me in the court of law. I also declare that I have never been caught using Unfair Means or
any Disciplinary action has been taken against me. If I was charged for using Unfair Means, the
punitive duration is over and charges have been cleared. I have read carefully and have understood
all rules as mentioned in the University Rules and Admission Brochure. Furthermore I also declare
that if my application is found to contain incorrect/false information regarding my Name, Birth Date,
Gender, Religion, Domicile, Weightage, Caste, Horizontal Reservation, Marks obtained or any other
field, my application is liable to get cancelled, and I will have no objection in getting disqualified for
admission to the concerned course/college.

Signature of Parent/Guardian Signature of Candidate

Printed: Friday, May 24, 2019 12:25 PM Page: 1/2


Patliputra University, Patna
Under-Graduate (UG) Admission Registration Form
SESSION 2019 - 2020
URN # 19G0064722 Reg. Date : 24 May, 2019 11:37 AM
Date: Date:

Options checked during registration


»
Document Checklist
NOTE: Mark the number of documents ( Photocopy/Xerox) attached by the Candidate during form submission to the college

Xth Marksheet Xth Certificate


XIIth Marksheet Last Exam Passed Marksheet
Recent Passport Sized Photograph Scanned Signature
Domicile (for other state) Certificate for Kashmiri Resident
Certificate for Category Certificate for Sub-Category
Documents for Claiming Weightage Other Certificate/Document

Printed: Friday, May 24, 2019 12:25 PM Page: 2/2

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