CHANDRA BHANU GUPTA KRISHI MAHAVIDYALAYA BAKSHI KA TALAB, LUCKNOW (AFFILIATED TO LUCKNOW UNIVERSITY) B.Sc. (Ag.) Entrance Exam 2012
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1 Serial No.: CHANDRA BHANU GUPTA KRISHI MAHAVIDYALAYA B.Sc. (Ag.) Entrance Exam 2012 Last date for submission of Application Form Without late fee: 10/05/2012 With late fee (Rs. 200/-): 15/05/2012 Cost of Application Form Rs. 20/- Entrance Exam Fee Rs. 500/- 1. APPLICANT'S NAME (according to the High school certificate) - (i) IN HINDI... attested by the Principal of College last attended 2. FATHER'S NAME (according to the High school certificate) - (i) IN HINDI MOTHER'S NAME (according to the High school certificate) - (i) IN HINDI DATE OF BIRTH - DAY MONTH YEAR 5. SEX - MALE FEMALE 7. CATEGORY (Please tick ( ) in the box) (i) GEN (ii) OBC (iii) SC (iv) ST (v) College Employee 8. QUALIFYING EXAM GROUP (Please tick ( ) in the box) (i) Intermediate (Ag.) (ii) Intermediate (Bio.) (iii) Intermediate (Maths)
2 9. QUALIFYING EXAMINATION (Please tick ( ) in the box) (i) Appearing (ii) Passed 10. ARE YOU SPORT PERSON? YES NO IF YES WHETHER (i) District Level (ii) State Level 11. DETAILS OF BANK DRAFT (i) Draft No (ii) Issue Date -...(iii) Amount Rs (iv) Name & Branch of the Bank ADDRESS Mailing Address - Permanent Address - PIN CODE... Phone/Mobile... PIN CODE... Phone/Mobile DECLARATION I... hereby declare that all the particulars stated above have been filled in by me in my handwriting and true to the best of my knowledge and belief and no fact has been suppressed/distorted. I have read the instructions and I shall abide by the terms and conditions there in. In case any information furnished by me is found wrong at any stage my candidature for the entrance test be cancelled outright without giving me any opportunity and further disciplinary action be also taken against me including cancellation of admission/degree acquired. Further, if admitted I promise to abide by the rules and norms of discipline of the college I join. Signature of Candidate Date : Place : APPLICATION FORWARDING CERTIFICATE (Only appearing students) This is to certify that Sri/Km./Smt Son/Daughter/Wife of Sri......was a student of this College from... to... during the above period of his/her stay in the College, his/her conduct has been good and to the best of my knowledge/record of the College, he/she bears a good moral character. Signature of Father/Guardian CERTIFICATE IN RESPECT OF SON/DAUGHTER/SPOUSE OF THE EMPLOYEE (of C.B. Gupta Agriculture College, B.K.T., Lucknow) I... hereby certify that Sri/Smt father/mother/husband/wife of Sri/Km./Smt. who has applied for the admission to an B.Sc.(Ag.) programme through Entrance Exam 2011 holds the regular post of... in this College. Date : / / 2012 Signature with seal of the Principal Date : / / 2012 Signature with seal of the Principal - 2 -
3 CHANDRA BHANU GUPTA KRISHI MAHAVIDYALAYA B. S c. ( A g. ) E n t r a n c e E x a m Admit Card (Filled by office) Roll No:... Date: Examination Center: CHANDRA BHANU GUPTA KRISHI MAHAVIDYALAYA Time: (Filled by Student) Name :... Father's Name :... Mother's Name :... attested by the Principal of College last attended Exam Co-ordinator Roll No:... (Filled by Student) CHANDRA BHANU GUPTA KRISHI MAHAVIDYALAYA B. S c. ( A g. ) E n t r a n c e E x a m Verification Card Name :... Father's Name :... Mother's Name :... attested by the Principal of College last attended Student's Signature Invigilator's Signature - 3 -
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5 13- ikb~;dze esa lhvsa de dk vf/kdkj fo'ofo ky; ds ikl lqjf{kr gsa 14- izos'k ijh{kk lecu/kh vfhkys[k dk;kzy; esa dsoy N%ekg ds fy, lqjf{kr j[kk tk;sxka 15- ijh{kk d{k esa eksckbyqksu] dsydqysvj vkfn ys tkuk gsa 16-,d viuk irk fy[kk fyqkqk 9 x 4 bap dk ftl ij :0 22@& dk Mkd fvdv yxk gks] vkosnu&i= ds lkfk vo'; layxu djsaa 17- vkosnu&i= ds lkfk izos'k ijh{kk 'kqyd :0 500@& dk jk"vªh;d`r csad ls tkjh csadmªk V tks "Principal, Chandra Bhanu Gupta Krishi Mahavidyalaya, Bakshi ka Talab, Lucknow" ds uke ns; gks] layxu djsaa fcuk izos'k ijh{kk 'kqyd ds vkosnu&i= fujlr dj fn;k tk;sxka 'kqyd dsoy csad Mªk V ds :i esa gh Lohdkj gksxk] udn ;k psd }kjk Hkqxrku eku; ugha gksxka 18- izos'k ijh{kk vkosnu&i= fcuk foyec 'kqyd ds fnukwad 10&05&2012 rfkk :0 200@& foyec 'kqyd ds lkfk fnukwad 15&05&2012 rd egkfo ky; dks izkir gks tkuk pkfg,a fu/kkzfjr frffk ds ckn izkir gksus okys vkosnu&i=ksa ij fopkj ugha fd;k tk;sxka 19- vkosnu&i= ds lkfk gkbzldwy vadi=] izek.ki=] o b.vjehfm,v izfke o"kz vadi= layxu djsaa vu;fkk vkosnu&i= fujlr fd;k tk ldrk gsa 20- vu; finm+koxz@vuq-tk-@vuq-t-tk-@vu; osvst dk ykhk ysus okys Nk= l{ke vf/kdkjh }kjk tkjh izek.ki= layxu djsaa 21- dei;wvj [kkuksa esa gkbzldwy çek.ki= ds vuqlkj ekrk o firk ds uke ls igys Jherh@Jh dk iz;ksx u djsa rfkk,d [kkus esa dsoy,d gh v{kj dk iz;ksx djasa tsls%& V I K A S K U M A R S I N G H 22- izos'k ijh{kk ls lecfu/kr lelr lwpuk;sa,oa ifj.kke egkfo ky; ds uksfvl cksmz ij rfkk egkfo ky; dh osclkbv ij miyc/k jgsxka - 5 -
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