SAVITRIBAI PHULE PUNE UNIVERSITY

Roll No/Admission No.

(for office use only)
Application for Eligibility
Form fees:Rs.50/- (For Under Graduate Courses only)
__________________________________________________________________________________________

I wish to apply for the Eligibility for the academic year : 20___ - 20___

1. Name of the Course to which Admission is sought:

___________________________________________________________________Year: 1st / 2nd / 3rd / 4th / 5th

2. Name of the Applicant (in English Capital Letters)

Name as per last Mark sheet should be mentioned. N.R.I. Student should write their name as it appears in
their Passport.
_________________________________________________________________________________________
3. Mother's Name:________________ 4. Aadhar No.:_________________________
5. Mobile No.: ____________________ 6. PAN No.:_________________________
7. Email Id:________________________ 8. Type: Maharashtrian / Non-Maharashtrian
9. Nationality: _________________ 10. Religion:________________________
11. Gender: Male/Female/Transgender 12. Date of Birth: _____ _____ __________
DD MM YYYY
13. Category (Tick mark √ in applicable box)

Open SC ST DT(A) NT(B) NT(C) NT(D) OBC SBC SEBC EWS

(If you belong to any of the Reserve category attach a certificate of a Competent Authority in Support of it.)

1) Do you belong to DT(A), NT(B), NT(C), NT(D), OBC, SBC, SEBC or EWS? Yes / No
(If yes submit the Non-Creamy layer certificate of a Competent Authority in support of it.).

14. Are you Physically Disabled? Yes / No ( If yes please specify type :_________________) *

15. Particulars of the Qualifying Examination

1.Name of the Course:__________________________________________________
2.Duration of the Course:_________________________
3.Name of the University:
______________________________________________________________________
4.Name of the College/Institute/University Dept.:
______________________________________________________________________________________

Seat No. Month & Year of Passing Percentage Class/Grade

5. Please specify Educational gap details if any

Last Examination Name Seat No. Month & Year of Passing Percentage Class/Grade

16. Are you belong to the Minority? Yes / No ( if yes please specify type which has given below)
Linguistic: Religion:

Signature of Candidate
 ANNEXURE I
AFFIDAVIT BY THE STUDENT

I, (full name of student with

admission/registration/enrolment number)

s/o - d/o Mr./Mrs./Ms

1) having been admitted to (name of the institution)
have received a copy of the AICTE regulations on Curbing the menace of Ragging in Higher
Educational Institutions, 2009, (hereinafter called the “Regulations”) carefully read and fully
understood the provisions contained in the said Regulations.
2) I have, in particular, perused clause 3 of the Regulations and am aware as to what constitutes ragging.
3) I have also, in particular, perused clause 7 and clause 9.1 of the Regulation and am fully aware of the
penal and administrative action that is liable to be taken against me in case I am found guilty of or
abetting ragging, actively or passively, or being part of a conspiracy to promote ragging.
4) I hereby solemnly aver and undertake that
a) I will not indulge in any behavior or act that may be constituted as ragging underclause 3 of the
Regulations.
b) I will not participate in or abet or propagate through any act of commission oromission that may
be constituted as ragging under clause 3 of the Regulations.

5) I hereby affirm that, if found guilty of ragging, I am liable for punishment according to clause 9.1 of
the Regulations, without prejudice to any other criminal action that may be taken against me under
any penal law or any law for the time being in force.

6) I hereby declare that I have not been expelled or debarred from admission in any institution in the
country on account of being found guilty of, abetting or being part of a conspiracy to promote,
ragging; and further affirm that, in case the declaration is found to be untrue, I am aware that my
admission is liable to be cancelled.
Declared this day of month of year

Signature of Deponent
Name
VERIFICATION

Verified that the contents of this affidavit are true to the best of my knowledge and no part ofthe affidavit
is false and nothing has been concealed or misstated therein.
Verified at (place) on this the (day) of (month) (year)

Signature of deponent

Solemnly affirmed and signed in my presence on this the (day) of month, (year)
after reading the contents of this affidavit.
OATH COMMISSIONER
 ANNEXURE II AFFIDAVIT BY PARENT/GUARDIAN

I, Mr./Mrs./Ms.
(full name of parent/guardian) father/mother/guardian of _____ (full

name of student with admission /registration/enrolment number),

1) having been admitted to (name of the

Institution), have received a copy of the AICTE regulations on Curbing the menace of Ragging in Higher
Educational Institutions, 2009, (hereinafter called the “Regulations”) carefully read and fully
understood the provisions contained in thesaid Regulations.
2) I have, in particular, perused clause 3 of the Regulations and am aware as to what constitutes ragging.
3) I have also, in particular, perused clause 7 and clause 9.1 of the Regulations and am fully aware of the
penal and administrative action that is liable to be taken against my ward in case he/she is found guilty or
abetting ragging, actively or passively, or being part of a conspiracy to promote ragging.
4) I hereby solemnly aver and undertake that
a) My ward will not indulge in any behavior or act that may be constituted asragging under clause 3
of the Regulations.
b) My ward will not participate in or abet or propagate through any act of commission or omission that
may be constituted as ragging under clause 3 ofthe Regulations.
5) I hereby affirm that, if found guilty of ragging, my word is liable for punishment according to clause
9.1 of the Regulations, without prejudice to any other criminal action that may be taken against my ward
under any penal law or any law for the timebeing in force.

6) I hereby declare that my word has not been expelled or debarred from admission in any institution in
the country on account of being found guilty of, abetting or being part of a conspiracy to promote,
ragging; and further affirm that, in case the declaration is found to be untrue, I am aware that my
admission my word is liable to be cancelled.
Declared this day of month of year

Signature of Deponent
Name:
Address:
Telephone/Mobile No:
VERIFICATION

Verified that the contents of this affidavit are true to the best of my knowledge and no part ofthe affidavit
is false and nothing has been concealed or misstated therein.
Verified at (place) on this the (day) of _ (month) and (year)_____________

Signature of deponent

Solemnly affirmed and signed in my presence on this the (day) of month, (year)after
reading the contents of this affidavit.

OATH COMMISSIONER
 विद्यार्थयाांचे उपस्थितीबाबत हमीपत्र

मी कुमार/ कुमारी.............................................................................................................

खालील सही करणार लेखी हमीपत्र ललहून दे तो / दे ते कक शैक्षणणक वर्षे २० - २० मध्ये

.......................................................या वर्ाात घेतलेला आहे .

शैक्षणणक वर्षे २० - २० मधील प्रथम व व्ददतीय दोन्ही सत्रातील माझी ननयलमत तासाांची
वर्ाातील उपव्थथती ७५ टक्कक्कयापेक्षा कमी असल्यास माझ्यावर ननयमानस
ु ार कारवाई होईल, याची
जाणीव आहे .

चालू शैक्षणणक वर्षााच्या प्रथम व व्ददतीय सत्रात मी ननयलमत तासाांना उपव्थथत राहण्याची हमी
दे तो/ दे ते. र्या सत्रामध्ये माझी उपव्थथती ७५% पेक्षा कमी असल्यामुळे माझा प्रवेश रद्द
झाल्यास माझी तक्रार असणार नाही अशी मी हमी दे तो / दे ते.

महाववद्यालय / ववभार्ाने घेतलेल्या सत्राांत परीक्षा अांतर्ात परीक्षा व इतर ववभार्ीय परीक्षा दे णे
हे माझ्यावर बांधनकारक आहे , याची मला जाणीव आहे . महाववद्यालयाने घालून ददलेली
उपव्थथती, परीक्षा सवलती इत्यादीांच्या ववदहत अटी मला मान्य आहे त.

संमतीबद्द्ल पालकांची थिाक्षरी विद्यार्थयााची थिाक्षरी

पालकाचे नाांव:-............................................ ववद्यार्थयााचे नाांव:.........................................

पत्ता:.............................................................. प्रवर्ा:........................................................

................................................................... प्रवेश घेतलेला वर्ा:-....................................

रोल नां:-......................................................... मो./ फोन नां-..............................................

इ-मेल-...............................................................
 विद्यार्थयाांचे शिष्यित्त
ृ ीबाबत हमीपत्र

मी कुमार/कुमारी.................................................................................................................

खालील सही करणार लेखी हमीपत्र ललहून दे तो / दे ते कक शैक्षणणक वर्षे २० - २०

मध्ये ..........................................................या वर्ाात घेतलेला आहे .

शैक्षणणक वर्षे २० - २० मधील अभ्यासक्रमाच्या वर्षाात ...........................वर्ा (Category)

मध्ये प्रवेश घेत असून शासनाच्या ननयम प्रमाणे समाजकल्याण / आददवासी ववकास भवन

ृ ीचा ऑन लाईन (on-line) ककंव्हा (off-line) ऑफ

हयाांच्या माफात अथाात शासनामाफात लशष्यवत्त
लाईन फॉमा मी शासना माफात ददलेल्या मद
ु तीत भरून दे ण्याची सवाथवी जबाबदारी माझी राहील
आणण माझी महविद्यालयात ७५% हजेरी नसल्यास शिष्यित्त
ृ ीचा अजा रद्द झाल्यास
सिाथिी जबाबदारी माझी राहील याची मला जाणीि आहे .

वरील फॉमा (form) शानामाफाात तसेच महाववद्यालयास भरून नददल्यास मला ओपण (Open)
प्रवेशाचे ननयमाप्रमाणे सांपूणा फी (open/ paying) भरावी लार्ेल याची मला जाणीव आहे . तसेच
या ववर्षयी कोणतीही तक्रार मी कोणाजवळ करणार नाही.

संमतीबद्द्ल पालकांची थिाक्षरी विद्यार्थयााची थिाक्षरी

पालकाचे नाांव:-......................................... ववद्यार्थयााचे नाांव :-...........................................

पत्ता:-....................................................... प्रवर्ा:..............................................................

............................................................... प्रवेश घेतलेला वर्ा:-.........................................

रोल नां:-.................................................... मो./ फोन नां-...............................................

इ-मेल:-.....................................................