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Cost of Application form Rs. 100/IX!II
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Di.rectorate
of Dis~anceEducation
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AllahabadAgnculturallnstltute . Deemed University
Allahabad
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- (U.P.)211 007
A University
APPLICATIONFORADMISSION(Spring-January 2009)
28084
Enrolment Number (For Office use only)
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GLOBAL"REACH
Form No.:
Note: This Form is to be filled in the applicant's own hand writing in Block Letters.
(Read Instructions carefully before filling the form)
i:
Photograph duly Signed by
candidate and attested by
the Co-ordinator DESC
Medium
OHindi
0 English
1.
Choice of DESC
2.
Full Name of the Applicant (as in the 10th Examination)
amdu
Please do not Pin or Staple
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5.
Date of Birth
6.
Gender
OMal~
0 Female
9.
7.
Resident
0 Urban
0 Rural
8. Category
OGen OOBe
0 se 0 Others
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OST
Demand Draft Details (DD to be made in favour of DDE, MIDU Alc payable at Allahabad)
(B) Dat~
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(C) Amount (in R~.)
(A) Number
.
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(D) Bank Name
STD~
Code~
11. Permanent Address for Correspondence
(Do not repeat name)
STD~
Code~
12. Qualification
010 + 2
0 U.G.Degree
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0
P.G.Degree
13. Programme applied for
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lli Subject
opted to< BAiMA
Signature Applicant
15. Details of Academic records (From 10th standard onwards)
Name of the
Qualifying Examination
16. De~ails of Professional
Year
Institution/ University / Board
Div/Grade
Percentage
Institution / University / Board
Div/Grade
Percentage
Education
Name of the
Qualifying Examination
Year
.
17. Employment
Employed
Details
~
if yes, level
Sr Mgt.
Designation
Name of the Company
Middle Mgt.
Others
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DECLARATION BY THE APPLICANT
I hereby declare that all particulars stated in this application are true to the best of my knowledge and belief. I have
read and understood all the provisions of the prospectus and agree to abide by them. In the event of suppression
or distortion of any fact like epucational qualification, nationality, study period etc., made in this Application Form, I
understand that my admission/registration is liable to be cancelled at any stage. I am fully convince wi[h all the
information given in the prospectus and understood all the rules & regulations.
Place:
Date:
Signature of Applicant
DECLARATION BY HONY. COORDINATOR, DESC
I am hereby forwarding the application of the student along with the requisite Demand Draft after verifying the
attached photocopies of testimonials and certificates with their originals. He/She is found eligible for admission to
the programme applied for.
DESC Code:
Place:
Date:
Signature & Seal of
Hony. Co-ordinator-DESC
GENERAL INSTRUCTIONSTO Fill THE ADMISSIONAPPLICATIONFORM
Entries made in this AdmissionApplication Form are to be read by Optical Magnetic Reader (OMR)
machine; therefore the applicant must fillthe form withdue care and accuracy.
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SI. No.1. Write the DESC Code from which the applicant is willingto correspond/study
with Allahabad Agricultural Institute - Deemed University.
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SI. No.2. Applicantmust fillhis/her name in block letters as mentioned in his/her 10th
Board Certificate.
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SI. No.3. Applicant must fillhis/her father's name.
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SI. No.4. Applicantmust properly mention his/her Nationalityin block letters only.
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SI. No. 5-8. Blacken appropriate circle.
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SI. No. 9(a) Write the DDNumber(s)
SI. No. 9(b) Write the date on which the DDhas been issued.
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SI. No. 9(c) Write theamountofthe DD
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SI. No. 9(d) Write the name ofthe Bank issuing the DD.
SI. No. 12 Blacken present qualification circle.
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SI. No. 13 Fillthe abbreviated name of programme as mentioned in prospectus.
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SI. No. 14. For candidate of BAIMAprogram~e. Candidate must fillthe opted subject in
givenboxas mentionedinthe prospectus.
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SI. No. 15. Candidate must fillin the correct details ofthere academic record as given and
stated incoloumns.
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SI. No. 16. Candidate must fillin the detail of the professional education, ifany.
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SI. No. 17. Ifcandidate is employed give details.
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Directorateof DistanceEducation
Allahabad Agricultural
Institute
Deemed University
Allahabad - 211 007
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Ph.:
0532.2684317
Fax:2695639website:www.aaidudec.orQ
(To be filled by the Candidate
in Block Lette~)
ITI:IIIIIJ
DESC Code
DESC Address :
IDENTITY CARD
For Office use only
RoIINo.~
Date of Issue
Paste your
stamp size
photograph
here
Studenfs Address :
(To be filled in Block Letters)
Name: Father's Name:
Lossofthis card shoudbe reportedto
Directorateof Distance Education
Allahabad Agricultural Institute
Deemed University
Allahabad211 007
Phone:
0532-2684317
Name of Programme:
STUDENTS SIGNATURE
AssistantRegistrar
DirectorateofDistanceEducation
AllahabadAgriculturalInstitute
DeemedUniversity
Alla habad
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IMPORTANT
Submission of Admission Application Form is not confirmation of Admission.
Admission will be confirmed by University after screening the form & document.
Photocopies of this Admission Application Form shall not be treated as valid for
admission.
Fee once deposited shall not be refunded or adjusted in any case.
No change of p(oar~mme shall be permitted in any case.
Cheques snatf Ab'ckcepted for the payment of Programme Feel Exam fee
Demand draft for Programme Fee I Exam Fee should be made in favour of "DDE,
AAI-DU Alc" payable atAliahabad.
Transfer of student from one DESC to another within the same cityldistrict will not
be entertained without "No Objection Certificate" of the existing DESC.
Receipt of Admission Application Form - Spring - January 2009
Application No
Name..................................................................................................
Father's Name
.
ProgrammeApplied
DESC Code.......................
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.Subject.................................................................................
...
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Demand Draft No
.Date
.Amount..............................
Bank Name and Branch.......................................................................................................................
Date
.
Seal & Signature of
Hony. Co-ordinator, DESC
Students are advised to keep this slip for record.
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