The document appears to be an application form for admission to Jagan Nath University, as it requests information such as the program being applied for, contact details, educational history, employment history, and payment details. It also provides instructions on filling out the form correctly and submitting required documents. The form collects essential applicant information needed to evaluate them for admission to educational programs at Jagan Nath University.

1. 1. Programme Applied For :
(for programme list see the Information Brochure)
2. Details of Qualifying Entrance Examination :
Name of Qualifying Examination Month & Year Score/Rank
3. Personal Details :
Name (Mr. / Ms.) :
DD MM YY (Years) (M/F) (Married/Unmarried)
Date of Birth : Age : Gender : Marital Status :
Category : Nationality :
4. Contact Details :
Correspondence Address : .............................................................................................................................................................
.............................................................................................................................................. Pin Code :
PhoneNo:......................................... MobileNo:.............................................. Mail ID:..............................................................
Permanent Address : .......................................................................................................................................................................
.............................................................................................................................................. Pin Code :
Phone No : ............................................................................ Mobile No : ....................................................................................
5. Details of Contact Person Incase of Emergency
Name : .............................................................................................................. Phone/Mobile No. : ...........................................
Address:.................................................................................................................................................................................................
..................................................................................................................................................................................................................
6. Parents Details :
Parent’s Name (Father & Mother) Occupation Phone No Mobile No Mail ID
Affix your recent
Passport size
photograph not
earlier than 6 month
Note: • Please read the form carefully before filling it.
• Fill the form in capital letters.
• Attach the required documents (Xerox copy) as mentioned in educational qualification.
• Attach the Result/Score/Rank of qualifying examination (if applicable).
Form No. JUNCR/2013-
Registration No.
(to be given by the office)
Application for Admission

2. 7. Educational Qualifications:
Examination
Passed
Name of The
Stream
Name of the School / College
and Board / University
Year of
passing
Subject Studied
Marks
Obtained
Maximum
Marks
% of
Marks
10th
12th
Graduation
Post
Graduation
Any other
Qualification
8. Awards and Achievements (if any) :
.............................................................................................................................................................................................................
.............................................................................................................................................................................................................
.............................................................................................................................................................................................................
.............................................................................................................................................................................................................
9. Participation in Extracurricular Activities :
.............................................................................................................................................................................................................
.............................................................................................................................................................................................................
.............................................................................................................................................................................................................
.............................................................................................................................................................................................................
10. From where did you come to know about Jagan Nath University, Haryana.
Friend’s/Family Newspaper Radio/T.V. Magazine
Please specify the name of magazine / newspaper
Any other (Please specify) : ___________________________________________________________________________
11. Employment History :
Work Experience:Yes No (If,YesTotalExperience:Years................................. Months..................................
Organization / Company Detail :
Name of Company Address Duration Designation Nature of Work Salary Drawn
12. Payment Details (applicable for downloaded forms only):
DD No. DD Date Amount Name & Address of Bank

3. Jagan Nath University
Sir,
I wish to apply for admission to Jagan Nath University, Haryana and promise to abide by the Rules & Regulations of the University. I certify that
the information given by me in this application form is correct and complete to the best of my knowledge and belief. I understand and agree that
misrepresentation, concealment or omission of any fact will justify the denial or cancellation of my admission, or expulsion from the University. I
further declare that I shall submit myself to the disciplinary jurisdiction of the University.
I have read and understand all the terms and condition for the admission mentioned in the
prospectus and agree to abide by them.
Signature of the Applicant
Declaration:
Place: __________________ Date:___________________
Place: __________________ Date:___________________
Parent’s Declaration
I undertake that my son/daughter ________________________________________ applying for admission to __________________________________
course will be subjected to the University Disciplinary Rules and Regulation. I further undertake to pay
all the dues of the University in time.
Signature of the Parent
Admission
We recommended the applicant for provisional admission to _________________________________________________ after having verified his/her
original certificates and accept prescribed fees from the applicant. However, his/her admission is subject to the approval of the Governing Body of
the University.
Admission Incharge Registrar
Specimen Signature
of the candidate
Course Applied for :
Test Centre : Date :
Name : Mr./Ms. _________________________________________________________________________
Date of Birth : __________________________________________________________________________
Father’s Name : Mr. ______________________________________________________________________
Address : _______________________________________________________________________________
_________________________________________________________________ Pin Code
Ph. No. ____________________________________ Mobile No. _________________________________
Acknowledgement Invigilators Signature
Affix your recent
colour passport size
photograph
Admit Card
Form No. JUNCR/2013-
(Students Copy*)
*Kindly retain this copy for future use Turn back for Rules and Regulations

4. Rules & Regulations
Non-Refund of Fees
The fees once paid are not refundable for any reason whatsoever.
Only Security Deposit will be refunded after making necessary
adjustments as required.
Cancellation of Admission
Jagan Nath University reserves its right to cancel the admission of
admitted student under any of the following circumstances:
• If the fee is not deposited by the stipulated date.
• If the candidate fails to join a particular programme by the
stipulated date, after the fee has been paid.
• If the candidate fails to furnish the proof of the stipulated
minimum qualification.
• If any student is found to be misbehaving or any other issue
regarding discipline at any point of time.
Attendance
Minimum 75% attendance is compulsory to complete the course.
Jurisdiction
Any dispute pertaining to admission or any other matter concerning
a student or alumnus of Jagan Nath University shall be subject to
the jurisdiction of the Haryana Court only.
Limitation Clause
No dispute shall be raised after the expiry of 30 days from the
date on which the process of admission and / or selection is
completed.
Agreement Clause
All admitted students shall be bound by the above mentioned Rules
& Regulations of Jagan Nath University.
University Campus
State Highway 22, Bahadurgarh-Jhajjar Road, Jhajjar, Haryana -124507
Phone: 01276-215749
Information Centers
JIMS, Community Centre,
Sector-3, Rohini, Delhi-110085
Ph:011- 45184152/53/54
JIMS, MOR Pocket 105, Kalkaji, New Delhi-110019
Ph:011- 40619200
E-Mail
Email ID: admission@jagannathuniversityncr.org
www.jagannathuniversityncr.org