D PUR DISP R LA AW COL C LLE EGE DHARMAN D NANDA DAS D AVEN NUE, LAST T GATE DIISPUR, GU UWAHAT TI 781006 P PHONE N 0361-22220380 No.: Form No o.: % markss in: Passporrt size photo Seriial No. C College Rolll No._______________ Nam me of the student s ________________________ AP PPLICAT TION FO ORM FO OR ADMIISSION INTO I 1sst SEMES STER OF F 5 Yearr B.A..LL.B IN NTEGRA ATED LA AW COU URSE 20115 SESSIO ON: 2015-1 2 16 1. Name of the Applicant (In CAPITAL letter)............................................................................... ..................................................................................................................................................... 2. Date of Birth/Age on 1st July 2015............................................................................................. 3. Place of Birth............................................................................................................................... 4. Sex............................................................................................................................................... 5. Nationality................................................................................................................................... 6. Religion....................................................................................................................................... 7. Name of Father............................................................................................................................ Occupation and Designation, if any............................................................................................ 8. Father’s Mobile / Telephone No. ............................................................................................... 9. Name of Mother.......................................................................................................................... Occupation and Designation, if any............................................................................................ 10. Mother’s Mobile / Telephone No. .............................................................................................. 11. Combined Annual Income of Parents......................................................................................... Correspondence Address with PIN Code (In CAPITAL letter).................................................. ..................................................................................................................................................... ..................................................................................................................................................... 12. Mobile / Telephone No. (with STD Code) ................................................................................. Email ID (Desirable)................................................................................................................... 13. Permanent Address with PIN Code (In CAPITAL letter) .......................................................... ..................................................................................................................................................... ..................................................................................................................................................... 14. Do you claim any reservation? (Write ‘Yes’ or ‘No’)............................................................... If Yes, do you be belong to SC / ST / OBC / MOBC / Persons with Disability? Enclose a copy of the certificate. 15. Languages known (underline your mother tongue).................................................................... …………………………………………………………………………………………………. 16. Are you availing any Scholarship/Financial assistance for pursuing the Course? If ‘Yes’, mention the name of the Authority with full address …………………………………………. …………………………………………………………………………………………………. 17. Are you a student of other course? If so, give details: FEES TO BE PAID 1. Admission Fees.................................................................................................................. Rs. 1500.00 2. Tution Fees......................................................................................................................... Rs. 11000.00 3. University Enrolment Fees................................................................................................. Rs. 200.00 4 Library Fees ........................ .............................................................................................. Rs. 200.00 5 Computer & Internet facility.............................................................................................. Rs. 200.00 6 Journal, News Paper etc..... ............................................................................................... Rs. 200.00 7 College Magazine ............... .............................................................................................. Rs. 150.00 8 Extra-Curricular activities .... ............................................................................................ Rs. 100.00 9 Students Association .......... .............................................................................................. Rs. 100.00 10 Student Aid Fund ………………………………………………………….... Rs. 100.00 11 Affiliation Fees .................................................................................................................. Rs. 900.00 12 College Development Fees ................................................................................................ Rs. 1000.00 13 Identity Card....................................................................................................................... Rs. 100.00 14 Library Caution Deposit..................................................................................................... Rs. 200.00 15 Library Card Fees............................................................................................................... Rs. 50.00 -----------------------------------------------------------------------------------------------------------------------------------GRAND TOTAL Rs.16,000.00 -----------------------------------------------------------------------------------------------------------------------------------(Rupees Sixteen Thousand only) ............................................................. Signature of the Applicant DECLARATION I hereby declare that all particulars given above are true and correct to the best of my knowledge and belief, and I agree to abide by all the rules & regulations of Dispur Law College, Guwahati that are in force from time to time. Further, I agree that the selection or rejection of my apllication by the College / University will be only on my merit and fees once paid will not be claimed for refund, and the place of jurisdiction for purpose of filing a suit or preferring a complaint on taking a legal proceeding against the Dispur Law College, with regard to any dispute arising in relation to admission, remittance of fee etc. will only be Guwahati City and not any other place. Date : Place : Signature of the Applicant. Checklist of Enclosures: 1. 2. 3. 4. HCLC/10th Admit Card & Birth Certificate. Mark sheet & Pass Certificate of H.S.L.C. Registration Certificate, Mark-sheet & Pass Certificate of qualifying Examination. Migration Certificate for the students passed the Degree Examination from other University except APPLICATION FORM FEE PAID (a) Amount (b) Date of Payment (b) DD No./ Receipt No. Accounts Officer ADMITTED/REJECTED Principal Dispur Law College Dispur, Guwahati Signature of Student