application B 2015 B - P.B.Siddhartha College of Arts & Science

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Application No.
Phone: 0866 - 2475966
PARVATHANENI BRAHMAYYA SIDDHARTHA COLLEGE OF ARTS & SCIENCE
SIDDHARTHA NAGAR - VIJAYAWADA - 520010
(An Autonomous College under the jurisdiction of Krishna University, Machilipatnam)
Sponsors : Siddhartha Academy of General & Technical Education
REACCREDITED AT ‘A’ LEVEL BY THE NAAC (2012-2018)
College with Potential for Excellence (Awarded by the UGC)
FOR OFFICE USE
Programme sought
Regd.No. & Date...................................................
Total Marks Secured
Admission No.......................................................
In the Qualifying Examination
(Including languages)
Date of Admission.................................................
Total Max.Marks
Roll No.................................................................
Grade
Affix Passport
Size Photo
APPLICATION FOR ADMISSION INTO 1st YEAR B.B.M, / B.Com.(TAX) / B.Com(Comp.App) / B.Com( Hons )
B.Sc.( MECs / CAMS/ MPCs/ BiBtC) BCA/B.Sc.(Hons) PROGRAMME
1.
Name in Full
:
d
d
m m
y
y
y
Date of Birth
2.
3.
(BLOCK LETTERS) (As per X Marks Statement)
y
Age in Years
Gender
Male
Nationality
:
Religion
:
Mother Tongue
:
Native Place
:
Mandal
:
District
:
Female
:
:
6.
Father / Guardian
5.
Mother
Self Employed worker
Housewife
Farmer
Self Employed worker
Government Employee
Farmer
Private Employee
Government Employee
State
Professional
Private Employee
Aadhar Card No.
Business
Professional
Industrialist
Business
(Photocopy to be enclosed)
:
Hailed from
Rural
Urban
Name of the Father / Guardian
Industrialist
7.
4.
Occupation of the
Name of the Mother
Educational Qualification/s of the Parent/s
Father
Address for Correspondence
Mother
Annual Family Income
PERMANENT
8.
Category
OC
Pin
Land Line
Mobile
email
BC
SC
A
B
C
D
ST
E
Others
Physically Challenged
LOCAL
Child of Armed Personnel
NCC
Pin
Land Line
Mobile
Games & Sports
(A copy of the relevent Certificates should be enclosed)
(Put  mark)
9.
(Put  mark)
Admission sought
Part (i)
Language Selected
Part (ii)
Telugu
Hindi
Others
B. Com
Hons
Tax
MPCs
CaMs
Specify..................................................
Com Applications
B.B.M
B.Sc
MSCa
BiBtc
Hons
B.C.A
Core Subjects in case of B.Sc.Candidates
1...........................................................
10.
Part (iii)
Sports
Medium of Instruction
English
NCC
NSS
3..............................................
Cultural
Yoga
HSCC
Others
Others
Specify..............................
Telugu
Particulars of the Qualifying Examination passed :
Name of the Examination :
IPE
Regd.No
11.
2.....................................................
CBSE
ICSE
Medium
Identification Marks
Month
Specify ..................................
Year
1......................................................................................
(As per X Marks Statement)
2......................................................................................
12.
Marks obtained in the Qualifying Examination
Subjects
Maximum
Marks
Subjects
Maximum
Marks
(Junior Inter)
Marks
obtained
(Senior Inter)
Marks
obtained
Total Marks obtained in all
subjects in two years togethar
(Max Marks)
(Marks obtained)
(Max Marks)
Grade
A
B
(>=75%)
(>=60% & <75%)
(Marks obtained)
C
D
Compartmental
(>=50% & <60%) (>=35% & <50%)
(A copy of the Marks Memorandum should be enclosed)
13.
Particulars of the Institutions where Studied Previously
Name of the Institution
Period of Study
X Class
Intermediate
14.
A) Proficiency in Co-curricular/Extra curricular Activities
Like Sports, Games, Literary, Cultural and Others (Mention Achievements Briefly)
B) Which Activity you like to persue in the College?
15.
Do you require Hostel Accommodation ?
Yes
/ No
DECLARATION BY THE CANDIDATE
I declare that all the above particulars are true and correct. If any information given above is proved false at
a later date or if the admission is made contrary to rules, I agree to forfeit my admission. I agree to abide by the
rules and regulations of the College in force from time to time. Further, I agree to abide by the decisions of the
Admission Committee in the matters of admission and the Principal of the College, after admission, in the matters
of my misconduct or misbehavior or breach of rules. I agree to take my T.C. and leave the College at any time if my
progress or conduct is not found satisfactory to the College authorities. If I discontinue my studies in the middle of
the academic year, for any reason, I abide by the rules of the college to discontinue.
STATION :
DATE:
SIGNATURE OF THE CANDIDATE
DECLARATION BY THE PARENT / GUARDIAN
I certify that the paticulars given by my son / daughter / ward are true and correct. I agree that my son /
daughter / ward would forfeit admission if any information given above is proved false at a later date or if the
admission is made contrary to rules. I agree for his / her admission into the College. I shall be responsible for the
payment of all the fees and other charges due from him / her in lieu of his / her studies in the College. I shall also
hold myself responsible for his / her good behavior and I agree to abide by the decision of the college authorities in
matters of misconduct or misbehaviour or breach of rules by my son / daughter / ward and I shall withdraw him/
her from the college, if the authorities are not satisfied with his / her progress / conduct without any claims.
STATION :
DATE:
Affix Passport
Size Photo
Father / Gardian
SIGNATURE OF THE PARENT/GUARDIAN
Affix Passport
Size Photo
Mother
(To be signed in the presence of the Principal)
UNDERTAKING
We read and understood “The Andhra Pradesh Prohibition of Ragging Act 1997” and bind ourselves to
abide by the rules under the “ Andhra Pradesh Prohibition of Ragging Act 1997” and my Son/Daughter/Ward shall
not indulge in ragging and that we shall be responsible for any offence under the “ Andhra Pradesh Prohibition
of Ragging Act 1997”
SIGNATURE OF THE PARENT/GUARDIAN
(To be signed in the presence of the Principal)
Contact No:
SIGNATURE OF THE CANDIDATE
(To be signed in the presence of the Principal)
Contact No:
FOR OFFICE USE
Received the following
Yes

Marks statement of the qualifying examination

T.C. & C.C.

Certified Photocopy of Caste Certificate or other
No
relevant Certificate of reservation

Date of Birth extract (S.S.C. Marks Memo)

Photocopy of the Aadhar Card
STATION :
DATE:
SIGNATURE OF THE VERIFYING ASSISTANT
Verified the applicaiton form with the original certificates at the time of interface meeting. The application is in order.
STATION :
DATE:
SIGNATURE OF THE ADMISSION INCHARGE
ADMITTED INTO 1st YEAR B.B.M, / B.Com.(TAX) / B.Com(Comp.App) / B.Com(Hons)
B.Sc.(MECs / CAMS/ MPCs/ BiBtC) BCA/B.Sc.(Hons) PROGRAMME
Second Language:
Core Subjects : 1
STATION :
Telugu
Hindi
2
DATE:
Others
Specify.............................
3
SIGNATURE OF THE PRINCIPAL