1. Name of the Applicant (In BLOCK LETTERS as in HSC Certificate) ( (b) Nationality. (c) Blood Group. 3. Date of Birth : Date Month Year

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1 Index No / /2018 Hard Copy Receipt Date.. /2018 LINGARAJ LAW COLLEGE ( C o n s t i t u e n t C o l l e g e o f B e r h a m p u r U n i v e r s i t y ) Paste Recent Passport size Photograph and signed across the photograph APPLICATION FORM FOR ADMISSION INTO LL.B - THREE YEAR COURSE(SEMESTER PATTERN) ACADEMIC SESSION : Name of the Applicant (In BLOCK LETTERS as in HSC Certificate) ( 2. (a) Sex : Male / Female (b) Nationality (c) Blood Group : : 3. Date of Birth : Date Month Year 4. Father s / Guardian s Name 5. Mother s Name 6. (a) Permanent Address (in detail) : (b) Present Address for correspondence (in BLOCK LETTERS and in detail) : (c) Id: (d) Cell phone No: 7. University last attended : 8. Berhampur University Registration No (For students of Berhampur University)

2 9. Mention if admission is claimed under : S.C. / S.T./ Persons with Disability (PwD)/ Reserved quota/concession Differently abled/ ESM/SDP/CoM/ Sports&Games (Please ( )whichever is applicable) 10. (a) Qualifying Degree Examination (Passed / Appeared) (b) Name of the University/Institution from which passed/appeared (c) Bank Draft No,Date and Amount. 10. EDUCATIONAL QUALIFICATIONS: Name of the University / Examination Council / Board H.S.C. or Equivalent Year of Passing Divn. And Distn. Marks Secured Maximum Mark Intermediate / + 2 Degree Exam B.A / B.Sc. / B. Com. / B.Tech / B.I.T / M.B.B.S or Equivalent Any Other Note: Candidates are required to submit attested copies of Mark Sheets (year-wise) and certificates of all the above mentioned examinations. Application incomplete in any respect is liable to be summarily rejected. DECLARATION I Sri/Ms. hereby declare that: I have not been admitted to any other courses(s) nor shall I appear at any other degree examinations as long as I continue my studies in the LL.B. (3 Year Semester pattern) course to which now I may be admitted and until I complete appearance at the said examination. If I am admitted to the LL.B. Course, I shall not take current admission in any other courses(s) or appear any other examinations, so long as I continue my studies in the LL.B. course and until I have fully appeared at the said examination. The particulars furnished in this form are true to the best of my knowledge and belief. I further declare that in case any of the above information is found to be incorrect at any time, I shall be liable to forfeit my seat and to such penal action as the college / university may deem appropriate. Date: FULL SIGNATURE OF THE APPLICANT 2

3 UNDERTAKING I Sri/Ms., an applicant for admission into the LL.B. (3 Year Semester pattern) Course of Lingaraj Law College, Berhampur during the session do hereby undertake that I am not a Government Servant or a servant in profit making institution of Government or Government Undertaking or Private Company. If it is subsequently detected so, I shall have no objection if my name be struck off the college rolls. Further, I undertake to abide by the rules of the College, Berhampur University / University Grants Commission and the Bar Council of India as prescribed from time to time. Date: FULL SIGNATURE OF THE APPLICANT CHECKLIST OF ENCLOSURES DURING SUBMISSION OF HARD COPY OF ADMISSION FORM a) One recent passport size colour photograph duly attested by gazetted officer. b) Self-attested copies of all mark sheets and certificates of all the examinations passed (HSC or equivalent, Intermediate/+2, B.A./B.Sc./B.Com./B.Tech./B.I.T./ M.B.B.S./+3 Degree/P.G. Degree, etc.). Candidates should submit copies of the marksheets/certificates of all the years. c) Self attested copies of certificate(s) in support of claim, if any, for a seat against the reserved quota as specified in item (9) of the application form. d) Self-attested copy of Registration Receipt (for Berhampur University candidates). Attested copy of the Migration Certificate of the students of other Universities. e) Bank Draft towards Processing-cum-Application Fee. f) Self attested copy of the CLC and Conduct Certificate of the Head of the Institution last attended. Note: Documents incomplete in any respect is liable to be summarily rejected. FOR OFFICE USE ONLY 1. Remarks: 2. Xerox copies verified by: D.A. Members of the Admission Committee 3

4 ANNEXURE - I AFFIDAVIT BY THE STUDENT I,... (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 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. 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). Solemnly affirmed and signed in my presence on this the (day) of.(month), (year ) after reading the contents of this affidavit. OATH COMMISSIONER 4

5 AFFIDAVIT BY PARENT/GUARDIAN ANNEXURE - II I, 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. 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 ). Solemnly affirmed and signed in my presence on this the (day) of (month),. (year ) after reading the contents of this affidavit. OATH COMMISSIONER 5

BERHAMPUR UNIVERSITY BHANJA BIHAR, BERHAMPUR , ORISSA

PROSPECTUS & APPLICATION FORM FOR M.PHARM COURSE, 2011-2012 BERHAMPUR UNIVERSITY BHANJA BIHAR, BERHAMPUR 760 007, ORISSA 1 BERHAMPUR UNIVERSITY PROSPECTUS FOR ADMISSION TO M.PHARM COURSE ACADEMIC SESSION