440 001 Application form for admission to MVSc. Degree Course 20

PRINT THIS FORM ON A4 SIZE XEROX PAPER ONLYMAHARASHTRA ANIMAL & FISHERY SCIENCES UNIVERSITYNAGPUR - 440 001Application form for admission to M.V.Sc. Degree Course 2012-2013OPEN / RESERVEForm No. _____________N.B. : Please read the instructions given in the prospectus carefully before filling the application form.To,The Registrar,Maharashtra Animal & Fishery Sciences UniversityNear Hanuman Temple, Futala Road,Telangkhedi, Nagpur - 440 001.Affixpassport sizepicture hereSir,I hereby apply for the admission to M.V.Sc. Degree Course for the academicyear 2012-13. I am fully aware of the fact that the seat will be offered to me strictlyon merit basis. I am also aware of the fact that this is a common application form forall the Colleges under the Maharashtra Animal & Fishery Sciences University(MAFSU), Nagpur. I have read the instructions given in the prospectus carefully andunderstood the same thoroughly.1) Applicant's Name - As appeared in B.V.Sc. & A.H. Degree / Grade Card(in block letters)SurnameFirst NameFather's NameMother's Name2) Applicant's Father's Name /Guardian's Name in full (if father/mother is not alive)SurnameFirst NameFather's Name3) Applicant's mother's Name in full (from her maternal side)SurnameFirst NameFather's NameMother's Name4) Applicant's permanent addressPhoneemail..1..

5) Occupation of Father / Guardian* (* If parents are not alive)6) Annual Income of Father / Guardian* from all sources (*If parents are notalive)Rs.If the annual income is less than Rs.1.00 Lakh, the candidate should enclose income certificate for the year2011-12 from the Tahsildar.7) Date of Birth :DATE MONTH YEAR8) Gender ( Ö ) : Male Female9) I have passed the Qualifying Examination (B.V.Sc. & A.H.) from the followingCollege & University :a) Name of the College :b) Name of the University :c) Month & Year of Passing B.V.Sc. & A.H.10) Academic Record :(a) CGPA / OGPA at the Qualifying Examination (B.V.Sc. & A.H. or Equivalent) :CGPA / OGPA obtained __________________ out of _________________(b)Aggregate Marks at XII Std.Maximum Marks Marks Obtained PercentageMarks obtained in BiologyMarks obtained in Chemistry(c)Aggregate marks at X Std.Maximum Marks Marks Obtained Percentage(d)Marks obtained in Science at X Std.Maximum MarksMarks Obtained..2..

11) CASTE :12) Category : If belonging to more than one category tick mark ( Ö ) allapplicable blocks.SC ST VJ/DT(a) NT(b) NT(c) NT(d) OBC SBC OPEN PH AG FF PD DP OS(Note: SBC candidate, if his caste was earlier under OBC category should tick mark both SBC & OBScategory blocks, enclose proof for OBC)13) CHECK LIST FOR DOCUMENTS ENCLOSED :Write your response asA) ESSENTIAL CERTIFICATES *(EN / NE / NA)1. Mark List / Grade card of B.V.Sc. & A.H. or equivalent2. Provisional Degree Certificate / Degree Certificate ofB.V.Sc. & A.H. or equivalent3. HSSC (XII) Marksheet4. SSC (X) Marksheet5. College Leaving Certificate / Bonafide Certificate6. Domicile Certificate,B) CLAIM FOR ADDITIONAL WEIGHTAGE MARKS / POINTS :a) NCC 'B' or 'C' Certificateb) Sports Certificatec) NSS Certificated) Research Publicationse) MAFSU Employee CertificateC) CLAIM FOR CONSTITUTIONAL RESERVATION :a) Caste Certificateb) Caste Validity Certificatec) Proof of CVC pending with Caste Scrutiny Committeed) Valid NCL Certificates for the year 2012-13..3..

D) CLAIM FOR OTHER RESERVATION (if applicable) :(if more than one, please specify)a) Certificate of Agriculturistb) Certificate of Freedom Fighter & Affidavitc) Certificate of Project Displaced Person & Affidavitd) Certificate of Defence Persone) Certificate of Physically HandicappedE) LIST OF DESIRABLE CERTIFICATES :a) "No Objection Certificate" fromemployer for in-service candidateb) If any, please specify ...................................................* EN = Enclosed, NE = Not Enclosed, NA = Not Applicable14) Total No. of documents enclosed :Place : ____________________Yours faithfully,Date : ____________________Signature of the candidate..4..

UNDERTAKING BY THE CANDIDATEI, …………………………… Son/daughter of …………………………..……. declare as under.1. That the particulars furnished by me in this application form are correct to the best ofmy knowledge and that if at any time any of the said particulars are found false, myadmission shall stand cancelled with effect from the date of my admission and that inaddition, the Vice-Chancellor of the University may at his discretion, take such other actionagainst me as he may deem fit and that the Vice-Chancellor’s decision in this behalf shall befinal and binding on me.2. That if I am admitted to the M.V.Sc. degree course, I shall fully abide by the rules andthe regulations made from time to time by the Maharashtra Animal & Fishery SciencesUniversity and /or the Dean / Associate Dean of the concerned college for the conduct anddiscipline of the students of this University and or concerned college and that in the event ofa breach by me of any of those rules and regulation’s the Vice-Chancellor of the University orDean / Associate Dean of the concerned College may at his discretion, take such actionagainst me as he deems fit and that the decision of the concerned authority in this behalfshall be binding on me.3. That during tenure of my career as a student of the Maharashtra Animal & FisherySciences University by any act of commission/omission on my part within or outside thepremises of the College/University, I shall not interfere in the orderly administration andmaintenance of discipline in the College/University. I shall not be involved in the act ofRagging and shall be punished as per “Maharashtra Prohibition of Ragging Act of 1999”, iffound involving in Ragging.4. That I voluntarily accept the course credit and common examination system ofeducation for course and such changes in the system of examination as may be made fromtime to time by the University, to which I am seeking admission and for all other higherstages in the course to which I would be subsequently, promoted in due course and at anytime in the event to my non compliance with or reluctance to fulfill the requirement of thecourse credit and common examination system of education, my admission to the concernedcollege and the Maharashtra Animal & Fishery Sciences University shall stand cancelled.5. That all the particulars furnished by me in this application form are correct to thebest of my knowledge and that I have not concealed any details with respect to my previousacademic career, such as punishment and penalties imposed by the college or University. Ifat any time it is found that any of the particulars furnished by me are distorted or that anydetails of previous academic career have been suppressed or withheld or concealed myadmission shall stand cancelled with effect from the date of my admission and that, inaddition the Vice-Chancellor of the Maharashtra Animal & Fishery Sciences University mayat his discretion take such other action against me as he may deem fit and that his decisionshall be final and binding on me.6. I will be abide by the academic rules and regulation of the University and otherconcern statutory body and changes made therein from time to time.7. My admission to the instruction course leading to the award of M.V.Sc. degree declarethat, I submit myself to the disciplinary jurisdiction of the Vice-Chancellor/ Dean/AssociateDean of the University/College, and shall observe the rules and regulations made byUniversity in this behalf.Place :Date :Signature of Candidate..5..

DECLARATION BY THE CANDIDATE’S PARENT/ GUARDIANI, Shri/Smt ...............................................................……..... Father / Mother /Guardian* of ........................................................... do hereby declare as under :1. That I undertake and bind myself to pay on behalf of my son/daughter/ward to theInstitute/ College/ University, by the due date such fees charges etc. which theCollege/ University may levy from time to time and that in the event of failure on mypart and /on the part of my son/daughter/ward the Associate Dean of the Collegemay take such action against my son/ward as he may deem fit.2. The particulars furnished by my son/ward in this application form are correct to thebest of my knowledge and belief. I know that if at any time, that said information isfound false, his/her admission shall stand cancelled with effect from the date ofadmission.3. That my annual income from all sources is Rs. ..................................... (in words Rs............................................................................)4. That I have read fully and understood the undertaking given by my son/daughter/ward as prescribed in annexure VIII and that I unequivocally endorse the same.Place : __________________Date : __________________(Signature of the Candidate’s Parent/Guardian*)* Only if the parents are not alive...6..

Primary ScrutinyRemarks of Verifying Officer( for Office use only )i) Application Form No. _______________________________________________________________ii)iii)iv)CGPA / OGPA at B.V.Sc. & A.H. ____________________________________________________Category __________________________________________________________________________No. of documents attached with the application form ______________________ (in words)v) Eligible / Non-Eligible ______________________________________________________________vi)If Non-Eligible the reason thereof ________________________________________________________________________________Signature_____________________________Name and Designation of Verifying Officer---------------------------------------------------------------------------------------------------Acknowledgement SlipReceived application form No.______________ on dated _____________________ along with___________________ No. (in words ____________________________________________) of certificatefrom Shri / Miss / Mrs. __________________________________________________________________for admission to M.V.Sc. Degree Course 2012-13.Place :SignatureName and Designation of Verifying OfficerDate :..7..