16. FORMAT OF FORM FOR CONDUCT, RESERVATION, DOMICILE STATUS AND MEDICAL CERTIFICATES (Annexures I VIII are required only at the time of Admission)

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1 16. FORMAT OF FORM FOR CONDUCT, RESERVATION, DOMICILE STATUS AND MEDICAL CERTIFICATES (Annexures I VIII are required only at the time of Admission) Annexure - I FORM 1 TWO POINTS CHARACTER AND CONDUCT CERTIFICATE Note: This Certificate must be signed by the Head of the Institution last attended of which the Candidate was a bonafide student prior to his/her admission at Doon University. The Certificate must be submitted in original along with the other required documents failing which he/she may not be permitted to appear before the Counseling Committee, and refused admission. I... Principal of the (Name of the Principal) (Name of the Institution)..... do hereby certify that (Full name of student) son/daughter of... has been a bonafide student/was a student of this Institution from to (Month and Year) (Month and Year) During his/her stay in this Institution, his/her conduct has been good and that: 1. He/ She has not taken part in any activity subversive of the rules, regulations and discipline of this Institution, and that 2. He/ She has never used unfair means in any examination conducted in or by this Institution during the above period.. (Signature and Name of the Principal) Place Date.. Institution Seal

2 Annexure II FORMAT FOR Uttarakhand Backward Class (UKBC) FORM 2 mrrjk[k.m ds vu; finm+s oxz ds fy, tkfr izek.k&i= dk izi= (UKBC) izekf.kr fd;k tkrk gs fd Jh@Jherh@dqekjh lqiq=@lqiq=h Jh fuoklh xzke rglhy uxj ftyk mrrjk[k.m jkt; dh finmh tkfr ds O;fDr gsaa ;g tkfr mrrjk[k.m yksd lsok ¼vuqlwfpr tkfr;ksa@vuwlwfpr tutkfr;ksa rfkk vu; finmsa oxksz ds fy, vkj{k.k ½ vf/kfu;e dh vuqlwph ds vurxzr eku;rk izkir gsa ;g Hkh izekf.kr fd;k tkrk gs fd Jh@Jherh@dqekjh mDr vf/kfu;e }kjk fu/kkzfjr Øhfefy;j ls vkpnkfnr ugha gsa Jh@Jherh@dqekjh rFkk vfkok mudk ifjokj mrrjk[k.m ds xzke Rkglhy uxj ftyk esa lkeku;r% jgrk gsa vh;fkhz ds glrk{kj % glrk{kj fnukad % iwjk uke % LFkku % eksgj ftyk vf/kdkjh@vfrfjdr ftyk vf/kdkjh@flvheftlvªsv@ Ikjxuk eftlvªsv@rglhynkj

3 Annexure -III FORM 3 vuqlwfpr tkfr@tutkfr (UKSC/UKST) ¼vH;FkhZ ds tue ftys ds ftyk eftlvsªv@izfke Dykl eftlvsªv }kjk izekf.kr½ izekf.kr fd;k tkrk gs fd Jh@Jherh@dqekjh lqiq=@lqiq=h Jh fuoklh xkao@ kgj rglhy ftyk izns k dk tue tkfr esa gqvk FkkA ;g tkfr vuqlwfpr tkfr@tutkfr;ksa vkns k ¼la kks/ku½,dv 1956 ds vurxzr Hkkjr ljdkj@mrrjk[k.m kklu@ ljdkj }kjk eku; vuqlwfpr tkfr@tutkfr gsa vh;fkhz ds glrkk{kj % fnukad % LFkku % glrkk{kj iwjk uke eksgj ftyk vf/kdkjh@vfrfjdr ftyk vf/kdkjh@flvh eftlvªsv@ijxuk eftlvªsv@rglhynkj

4 FORM 4 Annexure -IV mrrjk[kam ds Lora=rk lsukuh (Sub Category Children of Freedom Fighters) ml ftys ds ftykf/kdkjh }kjk izekf.kr ftldk vh;fkhz fuoklh gs izekf.kr fd;k tkrk gs fd Jh@dqekjh Jh@Jherh fuoklh ds iq=@iq=h@iq= ds iq=@iq= dh iq=h ¼vfookfgr½ gsa Jh@Jherh us Lora=rk laxzke esa Hkkx ysus ds dkj.k&¼tks ykxw u gks mls dkvus dk d"v djsa ½ 1- de ls de nks ekg dh oklrkfod vof/k ds fy, dkjkokl dk n.m Hkksxk gks] ;k 2- utjcanh ;k v.mj Vªk;y dsnh ds :Ik esa tsy esa de ls de rhu ekl jgsa gksa] ;k 3- de ls de 10 csrksa dh ltk ik;h gks] ;k 4- Qjkj?ksf"kr gqvk gks] ;k 5- Xkksyh ls?kk;y gqvk gks] ;k 6- ohjxfr izkir dh gks] ;k 7-,sls O;fDr Hkh tks is"kkoj dk.m ds jgsa gksa] ;k 8- HkwriwoZ vktkn fgun QkSt ds izekf.kr lsfud gks ;k 9- HkwrIkwoZ bafm;k bafmisamsl yhax ds izekf.kr lnl; gksa fvii.kh %,sls O;fDr ftugksusa ekqh ekaxh gks] mdr ifjhkk"kk esa lfeefyr ugha ekus tk;saxsa ;g Hkh izekf.kr fd;k tkrk gs fd Jh@dqekjh mijksDr Loar=rk laxzke lsukuh Jh@Jherh ds iq=@iq=h gsa vfkok muds iks=@iks=h gsa rfkk og mu ij oklro esa vkfjr gsaa vh;fkhz ds glrk{kj glrk{kj ftyk eftlvªsv fnukad % uke % LFkku % eksgj

5 Annexure -V FORM 5 mrrjk[k.m lsok ny (Sub Category Defence Personnel Wards) vfure ;wfuv ds vkfqlj dkekfumax }kjk izekf.kr ;g izekf.kr fd;k tkrk gs fd Jh iq=@iq=h fuoklh xk o@'kgj rglhy ftyk mrrjk[km fnukad dks lsok fuo`rr (Superannuated)@;q) esa ekjs x;sa@vaix gks x;sa os ml le; Hkkjrh; Fky lsuk] tylsuk@ok;q lsuk LFkku esa ds in ij dk;zjr FksA fnukad % ;wfuv dekfumax vkfqlj ds glrkk{kj LFkku % uke % Ekksgj ¼ftyk eftlvªsv }kjk izekf.kr½ ;g izekf.kr fd;k tkrk gs fd Jh@dqñ fuoklh xk o@'kgj rglhy ftyk mijksdr lsuk ny ds lsok fuo`rr (Superannuater)@;q) esa ekjs x;s@viax gks x;s dezpkjh tks mrrjk[k.m ds LFkk;h fuoklh gsa@fks] ds iq=@iq=h gsaa fnukad % LFkku % glrkk{kj ftyk eftlvªsv uke Ekksgj

6 Annexure -VI FORM 6 'kkjhfjd fodykax ds vf/keku ds fy, izek.k&i=-physically Handicapped ¼eq[; fpfdrlk }kjk izekf.kr½ izekf.kr fd;k tkrk gs fd Jh@dq iq=@iq=h] Jh@Jherh fuoklh xkwo@'kgj rglhy ftyk mrrjk[k.m tkap ds vuqlkj uhps fy[ks dkj.kksa ls 'kkjhfjd :Ik ls fodykkax gsa ¼dsoy eq[; fpfdrlk vf/kdkjh gh dkj.k fy[ksa½ ;g Hkh izekf.kr fd;k tkrk gs fd mijksdr fodykax flfkfr vh;fkhz ds f'k{kk izkir djus esa ck/kd ugha gksxha fnukad % LFkku % eksgj glrk{kj eq[; fpfdrlk vf/kdkjh uke Annexure -VII FORM 7 LFkkbZ fuokl izek.k&i= ¼'kklukns k la[;k 2588@,d&4@lk0 iz0@2001½ izekf.kr fd;k tkrk gs fd Jh@dq0@Jherh@ iq=@iq=h@ iruh Jh fuoklh xzke@eksg-@okmz rglhy ftyk mrrjk[k.m ds LFkk;h fuoklh gsa ;g Hkh izekf.kr fd;k tkrk gs fd mdr izek.k i= fuxzr djus ls iwoz fu/kkzfjr lelr ekunmksa dh Hkyh Hkkafr tk p dj yh xbz gs] vksj es tkap ls iw.kzr;k lurq"v gwwa glrkk{kj ftyk eftlvªsv uke % eksgj

7 Annexure VIII FORM 8 FORMAT FOR MEDICAL CERTIFICATE (TO BE OBTAINED FROM A CHIEF MEDICAL OFFICER OF DISTRICT) Name... Age... Sex... Roll No.... Category... Subcategory... Merit Position... Father's... To be filled by the candidate... L.T. M.I. Colour Vision Height Weight Chest Abdomen Without glass With glass History Operation Kock s Colic s BP Seizures Asthma Piles Diabetes E Pulse Tonsil DNS Hernia X A M Pallor L Nodes CSOM Hydrocele I N A Cardiovascular CNS T I Respiratory GIT O N Genitourinary Others Is the candidate physically handicapped : Yes/No If yes. Type of handicap (Please tick) : Type-I: One leg defective or missing Type-II: One hand defective or missing Type-III: One hand and one leg defective Any other type of handicap (Please specify) : Any other finding: Final result. (Fit/Unfit). Based on the medical standards given in Appendix III of the Prospectus for the purpose of Admission. Signature of Candidate Signature of Chief Medical Officer (with official stamp) Date:

8 Annexure IX Anti-ragging AFFIDAVIT BY THE STUDENT 1) (full name of student with admission/registration/enrolment number) S/o D/o Mr./ Mrs./Ms., having been admitted to (name of the institution), have received a copy of the UGC 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 Regulations and I 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 behaviour or act that may be constituted as ragging under clause 3 of the Regulations. b) I will not participate in or abet or propagate through any act of commission or omission 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 of the 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

9 Anti-ragging AFFIDAVIT BY PARENTS/GUARDIAN 1) Mr./Mrs./Ms. (full name of parent/guardian) father/mother/guardian of, (full name of student with admission/ registration/enrolment number), having been admitted to (name of the institution), have received a copy of the UGC 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 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 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) My ward will not indulge in any behaviour or act that may be constituted as ragging 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 of the Regulations. 5) I hereby affirm that, if found guilty of ragging, my ward 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 time being in force. 6) I hereby declare that my ward 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, the admission of my ward 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 of the 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

10 17. INSTRUCTIONS FOR CANDIDATES FOR FILLING THE APPLICATION FORM Please read the following Instructions carefully before filling the Application Form 1. Fill the Application Form in ENGLISH in legible manner in applicant s own handwriting using Black Ball-Point Pen. 2. All entries in the boxes must be made only in CAPITAL LETTERS only. 3. Please affix a recent Passport size (3.5 x 4.5) colour photograph in the appropriate space provided. The photograph should be self attested. 4. Tick ( ) the relevant box wherever provided. 5. The Candidate should write his/her name in the order as entered in his/her qualifying examination Certificate/ Mark sheet. 6. Write the name of Guardian, if father is not alive. 7. The Date of Birth must be as recorded in the High School/ School Leaving Certificate. 8. Please write your full mailing and permanent address with PIN CODE., Telephone No. and address, if any. 9. Please do not fill in place(s) meant for Office use. 10. The Candidates should refer to Section 9.1 of the Prospectus regarding Fee details. The details of the Bank Draft/ Cash receipt should be entered at the appropriate place. At the back of of the Bank Draft, Name, and address of the Candidate must be written. 11. An Incomplete or Illegible Application Form will be rejected. 12. Providing of false and inaccurate information will result in cancellation of admission. 13. Do not enclose any original copy of degree or certificate with the Application Form. Bring original and attested copies of degrees/mark-sheets/certificates, etc. at the time of Counseling. 14. Acknowledgement Card: One printed Acknowledgement Card is enclosed with the Application Form which should be detached and stapled with the Application Form by the candidate. The candidate is required to fill all the columns provided in the Acknowledgement Card. 15. Please attach Marks Sheet of Qualifying exam. 16. Please enclose TWO self-addressed envelopes (10x25cm) along with the Application Form. 17. Mail completed Application Form to the Coordinator of Admission, Doon University, Kedarpur, Ajabpur P.O., Dehradun , Uttarakhand, India. 18. The Candidates appearing in the qualifying exam will be allowed to sit in the Entrance Test provisionally subject to fulfillment of qualifying requirements at the time of admission, they must however submit the marks sheet of the last exam passed. 19. Last date for receiving completed Application Form: May 15, 2010, with late fee of Rs 100 upto 21 May, The University shall not be responsible for any postal delay or non-delivery of filled in Application form to the University before the due date or receipt of Admit Card by the candidate.

11 18. Annexure X Form Fee Rs.600/- DOON UNIVERSITY DEHRADUN (UTTARAKHAND) APPLICATION FORM FOR ADMISSION Self Attested Photograph Application Form No.. ROLL No. (Not to be filled up by candidate) Please tear the Application Form along the perforations carefully and staple it along with the acknowledgement card. 1. Candidate's Name: 2. Father's Name: 3. Mother's Name: 4. Date of Birth : Date Month Year 5. Sex : Male Female 6. Whether covered under Uttarakhand Reservation (Tick One) Yes No 7. Category : OBC SC ST Defense Freedom Physically Women Others(Specify) (Tick whichever is Person Fighter Handicapped applicable) 8. Nationality: 9. address: 10. Address : For Correspondence 11. Permanent Address : Phone No. Phone No.

12 12. Course applied for.: School st nd 13. Choice for Test Centre: 1 Choice 2 Choice 14. Qualifying Examination Passed Appearing Subjects in Qualifying Exam (+2/Graduation) Percentage /OGPA * Minimum 50% marks in the qualifying exam are necessary for general category students and 45% marks for SC/ST category students. The candidates who are appearing in the qualifying exam will be provisionally allowed to appear in the entrance test subject to above condition. 15. Details of application form fee deposited (Not compulsory for those who have obtained printed Prospectus). The crossed demand draft to be drawn in favour of Doon University Dehra Dun. DD No. & Date Name of Issuing Branch Amount (Rs.) DECLARATION I have carefully gone through all the details in the Prospectus and if selected for admission to Doon University, I undertake to abide by the Rules and Regulations of the University. I, the undersigned hereby certify that the information given above is accurate/correct and I am aware that providing incorrect information may result in the cancellation of my admission/continuance in the university at any stage at my cost, risk and responsibility. Place: Date: Signature of Candidate Counter Signed Signature of Parent/Guardian:

13 19. Application Form No.. ROLL No. (Not to be filled up by candidate) DOON UNIVERSITY DEHRADUN (UTTARAKHAND) ENTRANCE TEST 2010 REGISTRATION FORM Self Attested Photograph 1. Candidate's Name : 2. Father's Name : 3. Mother's Name : 4. Date of Birth : 5. Sex : 6. Postal Address : (For Correspondence) 7. Category : 8. Course Applied for : st 9. Test Centre : Choice 1 n d Choice Full Signature of the Candidate : 11. Signature of the Candidate to be taken at the time of the Test:- (To be filled in only in the Examination Hall) Candidate's Signature Name(s) of Invigilator Full Signature of Invigilator DOON UNIVERSITY DEHRADUN (UTTARAKHAND) ADMISSION TEST 2010 ADMIT CARD (PROVISIONAL) Application Form No ROLL No. 1. Candidate Name : 2. Name of the Course applied for : 3. Address : 4. Examination Centre Allotted : (To be filled by University Office) th Date: 13 June, 2010 Time: A.M. to 1.00 P.M. Coordinator of Admission Doon University Dehra Dun Self Attested Photograph

14 20. INSTRUCTIONS FOR THE CANDIDATE FOR ENTRANCE EXAMINATION 1. The candidate must bring the admit card with him/her to secure admission to the examination hall. 2. Method of answering question is given in the answer sheet. 3. No candidate shall bring into the examination hall any article other than those specified in this notice. Calculator/Slide Rule/Mobile is NOT allowed. 4. No candidate shall copy from the papers of any other candidate or permit his/her own papers to be copied, or attempt to obtain undue assistance of any description. 5. The doors of the examination room will be opened half an hour before the time fixed for commencement of the examination. 6. No candidate will be allowed to the examination hall after half an hour of end of the paper. 7. No candidate will be allowed to leave the examination hall before half an hour of starting of the paper. 8. No candidate, without special permission of the invigilator, shall leave his/her seat in the examination room until the end of the examination. 9. The candidate should not leave the room without handing over papers to the invigilator. No papers can be taken out of the examination hall. 10. The candidate is advised not to scribe or otherwise spoil the furniture and the Roll No. Cards placed at their desks. 11. Each candidate must write his/her own Roll No. at the space provided for. 12. Candidate will be required to sign the attendance when directed to do so by the invigilator. 13. Silence must be observed in the examination hall; any candidate found guilty, disorderly or of improper conduct will be expelled from the examination hall. 14. Candidate, who fails to observe these regulations, may be disqualified and debarred from appearing in this and any subsequent examination held by the University. 15. For obtaining acknowledgement of the receipt of the application, please attach a self addressed postcard along with application form.