ASSAM UNIVERSITY

E. EXTRA CURRICULAR ACTIVITIESi] Proficiency in extracurricular activities, if any ………………………………………………………………………………………………………………………………………………………………………………………………………….. (furnish documentary evidence)ii] Scholarship/Prize/Medals or any other distinction won, if any ……………………………………………………………………………………………………………………………………………………………………………….. (furnish documentary evidence)………………………………………………………………………………………………………….. (furnish documentary evidence)F. ADDITIONAL INFORMATION:i] Were you ever disqualified in your educational career? If so, give details …………………………………………………….………………………………………………………………………………………………………………………………………………………………………ii] Was any criminal proceedings instituted against you, or were you ever subjected to any disciplinary action?If yes give details. …………………………………………………………………………………………………………………………………………….iii] if there is any gap discontinuity in studies, state the reason(s) …………………………………………………………………..…………………………………………………………………………………………………………………….. (furnish documentary evidence)G. Application Fees: Rs…………………………………………………..DD. No. …………………………..dt. ………………………………………Application Downloaded from website should be submitted with application fee of Rs. 500/- (Rs. 400/- for SC/ST)by demand draft drawn on any Nationalized Bank payable at Silchar in favour of Finance Officer, AssamUniversity, Silchar.DECLARATION BY THE CANDIDATEI, …………………………………………………………………………………………………………………. son/daughter/spouse/wardof Shri/Smti …………………………………………………………………………………….., hereby solemnly affirm that I shallstrictly abide by the rules and regulations of the University as mentioned and enforced from time totime. I also declare that I have carefully read the prospectus for Admission to MBA Programme and Iagree to follow the admission procedure in the Department of Business Administration, A. U. and abideby the instructions issued in this regard by the University, or the concerned Department from time totime. All the statements made in this application are true and if at any stage subsequent to myadmission it is found that I have made an incorrect statement or concealed any fact or used anyfraudulent means for securing admission, I shall be liable to such disciplinary action as the Universitywould deem fit.Place:Date:Signature of the Candidate