Annexure-1

REGULAR SEAT / PAYMENT SEAT COLLEGE ALLOTTED…………………………………………………………

Admission Proforma- B.V. Sc. & A.H. degree course (Session 2017-18), RAJUVAS, Bikaner

Domicile State………………………… Whether orphan- Yes/No Aadhaar Card No………………………………………

RPVT Registration No.………………………………… RPVT Roll No.……………………………

RPVT Marks…………… Category-GEN/ OBC / SC/ ST/ STA Category Caste - …………………

Sex- Male / Female P.H.- Yes/No Religion …………………… Urban/Rural ……………………

Candidate’s Name (In Block letters)-…………………………………..………………………………………………

Father’s name (In Block letters)- …………………………………………………………………………………………

Mother’s name (In Block letters)- ………………………………………………………………………………………..

Date of Birth ………/………/…………… Age on 31-12-2017 – (Days)……. (Months)……. (Years) ………….. (Minimum age for all categories – 17 years, Maximum age for General category – 25 years & for all other categories -30 years)

Occupation of father (Govt./Private/Others) Occupation of Mother (Govt./Private/Others)

Only OBC Non-creamy layer candidates must mention annual income of Father & Mother and attach income certificate separately for financial year 2016-17. Annual Income of Father (2016-17). Rs. ……………………… Annual Income of Mother (2016-17). Rs. ……………………

Paste same colour

photo as uploaded in

RPVT-2017 online

registration form

(For Office Use Only)

Original Aadhaar card seen – YES/NO

Original Documents Produced [] Not produced [] Not applicable [N.A.]

01. Photo copy of Aadhaar Card

02. RPVT-2017 Online application form

03 RPVT-2017 Admit Card

04. RPVT-2017 Marks Sheet

05. Online Registration form for Rajasthan State Counselling

06. Bank Challan (University Copy)

07. Rajasthan Domicile Certificate

08. Caste Certificate (as applicable)

09. 10th Marks sheet & Certificate

10. 11th Mark Sheet

11. 12th Marks Sheet & Certificate

12. Character Certificate from Last Institute

13. T.C.

14. Migration Certificate

15. Annexure -1 to 5 (Download Proforma from website)

16. One set of self attested photocopy of original documents

Remarks: If original documents of candidate are submitted elsewhere then mention the name of college & course. Attach certificate issued by the Principal in this regard. Signature & complete name of the

document checking officer

Address for Correspondence ………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………..Village …………………………………………

PO: ………………………….Tehsil:…………………… Distt.:………………………………. State:………….……………PIN Code:………………

Mob. No. of candidate….………………….. Mobile No. of Parent- ……………………… Email ID- ………………………………………

Educational Qualification

Name of Examination Passed Year of Passing

% of Marks

Name of the School & Board

Secondary/ Equivalent Recognized Exam.

11th Class (with Physics, Chemistry & Biology/ Biotechnology)

Sr. Sec. / Equivalent Recognized Exam. (with Physics, Chemistry, Biology/ Biotechnology)

Marks obtained in Senior Secondary (10+2) or its equivalent recognized examination:-

Name of Subjects

Max. Marks Marks obtained

Total

Percentage of Marks obtained in Physics, Chemistry, Biology/Biotechnology & English in Senior Secondary or its equivalent examination

Theory Practical Theory Practical

Physics

Max. Marks __________

Marks Obtained __________

Percentage __________ Per cent

Chemistry

Biology/Biotechnology

English – –

Grand Total

Aggregate marks percentage (Physics, Chemistry, Biology/Biotechnology & English) General Category – 50% & all other categories – 47.5%

Signature & complete name

of the document checking officer

DECLARATION I hereby declare that the particulars stated in this admission proforma by me are true to best of my

knowledge and belief. In the event of suppression or distortion of any fact, I understand that my

admission/degree acquired is liable to be cancelled for which I shall solely be responsible.

Complete Signature of the candidate

(For Office use only)

………………………………. …………………………………… ………………………………

(Hemant Dadhich) (V.K. Choudhary) (Sunil Maherchandani)

Signature of members of Central UG Admission Board

Fee deposition detail

Book No. Receipt No. Deposit Date Amount (Rs.)

…………………... …………………… ……./….…/…….……. …………………….

…………………… …………………… ….…/….…/….………. …………………….

…………………… …………………… ….…/….…/…….……. …………………….

Annexure-2

HEALTH CERTIFICATE

No. ……………………………………………………………… Dated: ………………………

I do certify that I have examined …………………………………………………………………………………………

Son/Daughter/Wife of Shri…………………………………………………………….……………a candidate for admission

in the B.V. Sc. & A.H. Degree Course in the Rajasthan University of Veterinary and Animal Sciences,

Bikaner and cannot discover any disease, constitutional affection or bodily infirmity communicable or

otherwise, except. ………………………………………………………………………………………………

The candidate’s age according to his own Statement is about …………… years and by appearance, about

…………… years

I further certify the following as per medical Examination of the said candidate:-

1. Height……………………… cms

2. Weight…………………….. kg.

3. Vision : R.E. L.E. with Glasses R.E. L.E.

Distant :

Near :

4. Urine Colour……………………………………Specific Gravity………………………………………………………………

Albumin : Present/Nil, Sugar Present/Nil

On medical examination the candidate is found Fit / Unfit for admission to B.V. Sc. & A.H. Degree

Course.

Signature of the Candidate Signature & Seal of the Medical Jurist/M.O.

Place of Examination…………………………

Dated

Annexure-3

Annexure-4

Income Certificate of parents serving in the Government department (Rajasthan state/other state/central govt.) / Semi govt./ public sector undertaking organization/private organization

to be produced by Non-creamy layer OBC category candidates __________________________________________________________________________________

(Name of Department / Organization / Institute) No. ____________________________ Dated _____________ It is to certify that Mr. / Mrs. _____________________ is presently working in this department

on the post of __________________________________ in the pay band _____________

with grade pay of Rs. ______________ He/she was drawing his/her monthly salary as per

following details as on 31/03/2017.

1. Basic pay and pay band ________________

2. Grade pay _______________

3. D.A._____________

4. H.R.A.____________

5. CCA_____________

6. Any other allowances________________

(specify each of them)

His/her total gross salary (without any deduction) for the financial year 2016-17 as per Form

No. 16 issued to him/her was Rs. ________________.

His/her date of first appointment is _________________on the post of ______________in the

pay band/pay scale of Rs._____________ with grade pay/increment rate of Rs.__________

His/her date of allowing

1. First selection scale/promotion___________ in pay band/pay scale of Rs.__________ and

Grade pay of Rs.__________

2. Second selection scale/promotion____________ in pay band/pay scale of Rs.__________

and Grade pay of Rs.__________

3. Third selection scale/promotion____________ in pay band/pay scale of Rs.__________

and Grade pay of Rs.__________

His/her date of birth as per office record is__________

Full signature of issuing authority with seal of office

Annexure-5