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17. Academic Record : B,P.T. (Bachelor of Physiotherapy) Name of University Name of College Enrollment No. Year of Passing Year Max. Mark Marks Obtain Percentage I st Year TOTAL MARKS PERCENTAGE II nd Year III rd Year IV th Year Note: 1. Serial No. 15, 16 must be filled by B.P.T. / DANP/DCBR Candidate. 2. Serial No. 15, 16 &17 must be filled by M.P.T. Candidate. --------------------------------------- (Signature of Candidate) CERTIFICATE OF PRINCIPAL OF SCHOOL/COLLEGE LAST ATTENDED I, certify that Shri./Smt./Miss……………………………..S/o/D/o………………………... Shri/Smt ........................................................... of our School/College has passed/ appeared in all the subject of the following examination with particulars noted against each:-Higher Secondary Examination under Ten plus two (10+2) / Bachelor of Physiotherapy and has secured marks out of ---------------------marks. His / Her date of birth as extended in our school / college record is ...................................... He/She bears a good moral character. Date ………………….. Name & Signature of the Head master/ Headmistress/Principal with seal. Name:…………………….. 4
DECLARATION BY THE CANDIDATE I ..................................................... S/O/D/O,Shri/Smt. . ..................................... a candidate of …………………………………………………course of the Faculty of Medicine, Janardan Rai Nagar Rajasthan Vidyapeeth for the session …………….declare that: 1. I have carefully gone through the rules and regulations regarding Admission to the said course. I find myself eligible for the same and promise to abide by them. 2. I do solemnly affirm that the statement and information furnished by me as above and also in the enclosures submitted are true. I realize that, if any information furnished there in is found to be false in material particulars. I shall be liable to criminal prosecution as well as to forgo my admission and to be removed from the Institute, if already admitted. I shall abide by the decision of the Janardan Rai Nagar Rajasthan Vidyapeeth (University), Udaipur. 3. I also undertake to pay the Institution dues regularly. 4. I hereby agree, if admitted, to abide by the rules and regulation of the Institute of University, I undertake that so long as I am a student of the institute I will do nothing either inside or outside the Institute that will interfere with its orderly working and discipline. 5. If I am found involved in any type of the activity against the declared rules, already mentioned in the bulletin, my admission may be cancelled at any time without any notice. 6. I also declare that: (a) (b) (c) (d) (e) I have not been convicted of any criminal offence nor have I been released on bail in connection with a criminal case. No case of criminal offence or moral turpitude is pending against me in any court of law. No complaint or FIR has been lodged against me by the University/Principal of constituent college/school. I have not resorted to any act of in-discipline during the past year. I have not been restricted or suspended from any school/college/institution. Note: (a) to (e) if yes, please give in details in separate sheet. ------------------------------------ Signature of the Candidate Place : ---------------------- Date : ----------------------- In English : ………………………………. In Hindi : ………………..………………… 5
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Page 7 and 8: The application for admission shoul
Page 9 and 10: Specimen Signature ( for Office ) S
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