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    3 Third BDS Exam Form - 230417 - 111317

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    yuvrajsinh jadeja
    This document contains an examination form for a Third Year BDS program. It includes sections for information about the student, college, and examination details. The student is asked to provide personal details like name, category, address and contact information. They must also fill in details of previous examinations, subjects they want to appear for, and exemption requests if applicable. The form needs to be certified and signed by the college principal to confirm the student's eligibility to appear for the exam.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    3 Third BDS Exam Form - 230417 - 111317

    Uploaded by

    yuvrajsinh jadeja
    29 views3 pages
    This document contains an examination form for a Third Year BDS program. It includes sections for information about the student, college, and examination details. The student is asked to provide personal details like name, category, address and contact information. They must also fill in details of previous examinations, subjects they want to appear for, and exemption requests if applicable. The form needs to be certified and signed by the college principal to confirm the student's eligibility to appear for the exam.

    Original Title

    3-Third-BDS-Exam-Form_230417_111317

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    This document contains an examination form for a Third Year BDS program. It includes sections for information about the student, college, and examination details. The student is asked to provide personal details like name, category, address and contact information. They must also fill in details of previous examinations, subjects they want to appear for, and exemption requests if applicable. The form needs to be certified and signed by the college principal to confirm the student's eligibility to appear for the exam.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    29 views3 pages

    3 Third BDS Exam Form - 230417 - 111317

    Uploaded by

    yuvrajsinh jadeja
    This document contains an examination form for a Third Year BDS program. It includes sections for information about the student, college, and examination details. The student is asked to provide personal details like name, category, address and contact information. They must also fill in details of previous examinations, subjects they want to appear for, and exemption requests if applicable. The form needs to be certified and signed by the college principal to confirm the student's eligibility to appear for the exam.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 3

    SAURASHTRA UNIVERSITY.

    TH
    Re – Accredited Grade B by NAAC ( 4 CYCLE)
    SR. NO OF APPLICATION
    Examination Form THIRD YEAR B.D.S (NEW /OLD)
    (A) TO BE FILLED BY THE COLLEGE :

    COLLEGE NAME :

    To : TALUKO : POST : DIST :

    PROGRAM COURSE NAME : FACULTY :


    SR.NO OF APPLICATION : COLLEGE CODE :
    CENTRE CODE : APPEARING IN EXAM :
    ENROLLMENT NO : ENROLLMENT DATE :
    ELIGBILITY CERTI.NO : ELIGBILITY CERTI. DATE :

    (B) TO BE FILLED BY THE STUDENTS :


    SURNAME :
    CANDIDATE
    NAME :
    PASSPORT SIZE
    FATHER / HUSBAND NAME :
    PHOTOGRAPH
    WITH SIGNATURE

    SEX : (¡ ) : MALE : FEMALE ; CATEGORY ; SC : ST : SEBC : OTHER : PH :

    PERMANENT ADDRESS : CONTRONDENCE ADDRESS :

    TO : ……………………………………………TALUKO :……………………………… TO : ……………………………………………TALUKO :………………………………

    DIST : …………………………………………….POST : ……………………………….. DIST : …………………………………………….POST : ………………………………..

    PIN : ……………………………………….STATE : ………………………………………. PIN : ……………………………………….STATE : ……………………………………….

    EXAM TYPE : WHOLE : PART : ANSWERTING LANGUAGE : GUJARATI : ENGLISH : HINDI :

    MOBILE NO : E –MAIL ADDRESS :

    DETAILS OF PREVIOUS EXAM ATTACH MARKSHEETS OF ALL PREVIOUS EXAM :

    SR. COURSE SEMESTER EXAM MONTH & OBTUMMA TOTALM ATTEMAT % RESULT SELF ATTESTED MARKSHET
    NO. YEAR YEAR RKS ARKS NO. ATTETEH : (¡ ) (X)

    01 H.S.C.E.

    02

    03

    04

    05

    06

    I HAVE TO APPEAR IN THE FOLLOWING SUBJECTS.


    THIRD YEAR B.D.S. ( NEW/ OLD)
    TICK (¡ ) OR (X)
    CODE NAME OF SUBJECT
    SR.NO. ( NEW COURSE ) (OLD COURSE )

    7
    ENCLOSED : (¡ ) ABOVE SELF ATTESTED MARKSHET NO :
    3. EXAMINATION PARTICULARS
    I request exemption from the following subject/s as I have obtained necessary marks for
    Examination in the subject/s concerned i.e. 40 % or marks as prescribed form time to time in
    Subjects/ held in the year mentioned against them. An attested copy of Marksheet is attached
    herewith.
    Month & Year Subject Marks Obtained Seat No. University Centre Result

    Place : ……………………………………… Yours faithfully

    Date : ________________________________ ……………………………………………


    S Candidate’s Signature

    Certificate to be signed by the Principal of the College at which the candidate has studied
    I certify that Shri/Smt./Kum ____________________________________________________________
    has kept one term in my college by attending______________________ days out
    of__________________ days. He/She is a student of our college studying in FIRST YEAR has successfully
    completed the U.G.C. ENVIRONMENTAL STUDY COURSE as prescribed wide its D.O. Letter No.F.13-
    1/2000(EA/ENV/COS-I), Dt. 07-08-2014 (Ref. A.K./PARYAVARAN/1124/2015 Dt. 02/12/2015.)

    01 The attendance report for the respective term will be sent to the University by 20th March,201.

    02 I further certify that to the best of my knowledge and behalf; he/she is a person of good conduct and that is
    he/she has my permission to present himself/herself at the ensuing THIRD YEAR B.D.S. Examination whichever
    applicable.

    3. I Certify that he/she (a) has during this/previous academic year undergone medical examination held by
    authorized persons and (b) (i) as per O.182 he/she has satisfactory gone through the course of physical training
    periods during the academic year OR (ii) he/she regularly taken part in athletics of major sports during academic
    year as a member of the University athletics OR sports teams OR (iii) he/she is a member of the National Cadet
    Corps or he/she has been exempted from undergoing the physical training (1) on medical grounds as per rules in
    force OR (2) on other grounds laid down by the University.

    4 I also certify that the statements of the candidate regarding EXEMPTION claimed at the examination in a subject/s
    as above is/are correct and eligible for the exemption and he/she has not appeared in that / those subjects.

    5. I certify that he/she is eligible to appear for the respective exams as per the rules of the university, M.C.I. RULES.
    PLACE:…………………………………………………………………………………………………………………………………………………PRINCIPALSIGNATURE:……………………………………………………

    DATE: : ……………………………………… PRINCIPAL’SNAME____________________

    + To be struck off where it is not applicable.


    + Write your name in English in correct spelling. The spelling of the name written here shall be the spelling for
    University records and no change therein can be made afterwords. Please attach con attested copy of the
    statements of marks in supports of exemption claimed and passing the previous Examination.
    # Insert one of the centers announced by the University for this examination. Centre change is not allowed.
    Examinee Assurance.
    1 I shall not bring any kind of written material or written notes and would not write anything related to exam (anywhere) on any
    object in the examination hall during the time of examination.

    2. I shall not converse to other examinees, and shall not try to send any message or would not misbehave which can create
    disturbance in the examination hall during the time of examination.

    3. I shall not indulge in any act of misbehavior in the examination hall.

    4. I shall not carry the main supplementary written or blank answer sheets given to me while I leave the examination hall after the
    examination gets over, nor shall I indulge in any such activity which would lead to attempting the examination from outside the
    examination hall. I am aware that such activities might lead to disciplinary actions resulting in being expelled from the
    examination hall and getting reported to the university.

    5 I am aware that I shall be liable for punishment if I indulge in any undesirable activity or misbehave with the Junior Supervisor, or
    Senior Supervisor or any other University official on duty in the examination hall.

    6. I hereby furnish the assurance that I shall act in accordance with all the University rules and regulations regarding examination
    and would be liable for any punishment the University deems fit for the violation of the said rules and regulations.

    7. I hereby furnish the assurance that I shall follow all the instructions given on the answer sheet during the time of examination.

    8. I hereby assure that I am eligible to appear for the respective exam as per rules of the university, M.C. I. RULES.

    ___________________ __________________
    Examinee’s Signature 2 Principal’s Signature and Stamp
    DATE

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