Application Form - Banasthali University

BANASTHALI UNIVERSITY
P.O. Banasthali Vidyapith, Rajasthan - 304 022
Course applied for
Please see Page No...............in the brochure)
Course Code :
GYAN GANGA : Banasthali Online
Application Form
Paste your
self attested
photograph
Course Title :____________________________
(For Office use only)
Enrolment No. : Registration ID :
It is mandatory to fill each column.
1. Candidate's Name
___________________
First
__________________
Middle
___________________
Last
2.
Father's Name
___________________
__________________
___________________
Mother's Name
___________________
__________________
___________________
3.
Date of Birth
DD
MM
YYYY
4.
Sex
Male
Female
5.
Are you an Indian resident
Yes / No
6. Nationality_________________________
7.
8.
9.
Address for
Correspondence
Telephone No.
(e.g. : 91-1438-228647)
Mobile No.
_________________________________________________________________
_________________________________________________________________
City _________________ State ____________________ Pin ________________
( Country Code) _______ (STD Code) _____________ No. __________________
_________________________________________________________________
10. E-mail*
__________________________________@_____________________________
11. Are you a full time student of Banasthali University
If yes,
The year from when studying in Banasthali
The current course : _________________________________________________________________________
Student- ID
*This field is a must to be filled.

12. Academic Qualifications :
S.No. Exam. Passed Board / University Year Subjects taken
Percentage/
Division
* Please attach attested copies of your Seconday School Certificate as Date of Birth proof and copies of marksheets and certificates
required for eligibility.
13. Work Experience (if any) :
S.No. Name of Organization Designation Duration
Total experience
in years
14. Examination centre (tick one)
Ahemdabad
15. Fee Details :
Banasthal
i
Bangalore
Bhopa
l
Dehradun Delhi Jaipur Kolkata
Crossed Demand Draft No. ______________________ dated ____________________________ Drawn in
favour of __________________________________________________________________________/Cash
of amount _______________________________________________________________is being deposited.
(Demand draft should be drawn on any Bank in favour of Banasthali Vidyapith payable at Banasthali or
Jaipur. The student is advised to write the name and address at the back of the demand draft.)
Declaration by the Candidate
I declare that I have carefully read and understood the details of the above programmes and that I have given the
true and correct information in the form. The University has the right to take legal action in case any of the
information given by me is found incorrect.
Date : ________________
Place : _______________
(Signature of the Student)
All disputes are subject to Tonk jurisdiction.

BANASTHALI UNIVERSITY
Acknowledgement Card
For Office use only
Please ensure in the submission :
1. Attested Copy of Certificates.
2. A recent Passport size Photograph
duly attested
3. A Bank Draft/Cash receipt for fee
4. The student signature at the end of
the form
To be filled in by the Candidate
Received an application form from
Place ——————————————
For the course
Course Code :
Course Title : —————————————
—————————————
Date :
For Secretary
Banasthali University
Please affix a Rs. 5/- stamp on back
(Address to be filled in by the Candidate)
Affix Five
Rupees Stamps
here
To,
______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
Pin