Mahatma Gautam Buddh Mahavidyalya - Affiliation of the Institute

B T C/. Entrance Exam Roll No. :

Gen. Rank :

Marks Obtain :

Two Teaching Subjects :

(Art/Science/Comm)

from group 1	from group 2

Name

Father's Name

Mother’s Name

Guardian’s Name

Permanent Address

Pin Code

Contact No

If same Present Mailing Address select this box.

Present Mailing Address

Pin Code

Contact No

Date of Birth

Period of Residing in U.P

Category

OBC

GEN

MINORITIES

Record of Examination Passed (Submit Self Attested Copies of Mark sheets & Certificates). :

Examination	Year	Roll No.	Board/university	Name Of the college	Subject/ Stream	Max Marks	Marks Obt	Div.

High School

Intermediate

Graduation

Post Graduation

Note: Original copies of all certificated will be produced at the time of admission. Transfer Certificate (T.C) and Character Certificate will be submitted in original. Migration will be submitted in original with Examination Form.

Declaration

I declare that the information furnished by me in this application form is correct in all respects. In case any information is found to be false, this shall entail automatic cancellation of May admission decides rendering me libel to such action as the college/University may decide proper.