ADITYA DEGREE COLLEGE

ADITYA NAGAR, SURAMPALEM

Application for Admission

Registration No: _______________ Passport Size

Admission No: _______________ Colour
Category of Admission: Management / Convener / Spot Photograph
Course Name: AKNU-BBA BA
Name of the Telecaller: _______________
Name of the PRO: _______________

Student Details

Name of the Student : __________________________________________

Student Aadhar Number : __________________________________________
Gender : Male / Female
Date of Birth : DD / MM / YYYY
Father’s Name : __________________________________________
Mother’s Name : __________________________________________
Occupation of Father : ___________________________
Religion, Caste & Sub Caste : ___________________________
Mother Tongue : ___________________________
Primary Contact Number : ___________________________
Secondary Contact Number : ___________________________
e-mail ID for correspondence : __________________________________________
Permanent Address : __________________________________________
__________________________________________
__________________________________________
Address for Correspondence : __________________________________________
__________________________________________
__________________________________________
__________________________________________

Preferred to : Day Scholar / Hostler

Local Guardian Details(In case of Hostler)

Name of the Guardian : __________________________________________

Contact Number : ____________________________
Guardian’s relationship with student : ____________________________
Guardian’s Address : __________________________________________
__________________________________________
__________________________________________
__________________________________________

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Date :
Name of the Receiver :
Signature :
 Student’s Academic Record

A : Academics

Medium
Name of the Name Total
Hall Ticket of State / Year of Group Total Class /
Course School / of the Marks
No Instructi Country Passing % % Division
College Board Obtained
on

SSC

Inter /
Diploma
(Group)

B : Identification marks : 1._________________________________________

2._________________________________________
C: Eligibility Test Details : Rank Secured : ________________
Hall Ticket No: ________________

Fee Structure
1nd Year 2nd Year 3rd Year

Tuition Fee

Special Fee

Total

Principal Director
Self Declaration

Declaration by Student

I hereby declare that the particulars furnished overleaf are true to the best of my knowledge and I did not suppress
any relevant information. I am aware that my admission is liable for cancellation at any stage, if I have suppressed
any relevant information. I further declare that I am aware of the Institution / University rules that a minimum
attendance of 75% is required to write for the Final examinations else will not be allowed for the same. I promise that
I will abide by the Rules & Regulations stipulated by the Institute from time to time.

Signature of the Student

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 Declaration by Parent

I hereby undertake that if my ward is admitted, I will ensure that he/she will observe all Rules & Regulation of the
Institute and will pursue his/her studies regularly without violating aforesaid rules. I further undertake that I will pay
all the prescribed fees within the stipulated time and I will financially support my ward during his/her years of study
at the Institute. I am also aware of the University/Institution rule that my ward should put in a minimum attendance
of 75% to write the Final Examinations and I assure you that we will abide by this condition

Signature of the Parent

SWORN AFFIDAVIT

I, _______________________________ S/o, D/o ______________________________________ aged _____ years,

residing at
______________________________________________________________________________________
__________________________________________ do hereby solemnly and sincerely affirm and state as follow:

I have been admitted in the Course of ______________ at Aditya Global Business School, Surampalem.

I understand that once a seat is allotted by the Convener / Management / SPOT and if the student withdraws from the
college or opts for leaving the college for any reason whatsoever once the admission formalities are completed and
closed the seat has to be kept vacant throughout the subsequent years also as per AICTE and APSCHE directives. I
very much appreciate that if that sort of situation arises because of me, the college will be sustaining financial loss to
the extent of the Tuition fee payable for remaining years of study. Hence I hereby expressly agree to affirm that the
Tuition fees and other charges will be paid by me in the eventuality of my discontinuation of studies for whatever
reason and only then I shall seek for return of my original certificates.

I am giving this undertaking / affidavit of my free will and volition voluntarily and under no coercion or duress, as I
very much appreciate the position of the college.

Deponent

I understand fully well all the above affidavit statement that my ward has given below and I also hereby state that I
will abide by each and every statement given in this affidavit by my ward.

Parent

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