Valid for Dec. 2018 & May 2019 Session ESTD. 1926 Now Telephone Nos, = oe Sangit Samiti, Allahabad “fetes otes: cso cite ‘Website: worn prayagsangestsamitco.n IMPORTANT INSTRUCTION Enmal poe rogverexames@ gmal\con eho Entries are to be filled in completely and legibly in ENGLISH only since the work will be we computerised. Incomplete forms will be rejected straightway. 2. Fee should be sent through Bank Drafts in favour of Registrar Prayag Sangit Samiti Allahabad. Photo of the Postal Orders may be used in exceptional cases. candidates | 3. Two copies of attested passport size photograph must be pasted by_all candidates from Ist appearing in to Vil year in the space provided fo this purpose. the Exam. 4. Candidates for Prabhakar or Praveen Examination must have passed High School / Equivalent should be amination and in support of which attested copy of Certificate / Mark-Sheet must be submitted. attested by the theory examination willbe allowed upto IInd year only after obtaining prior permission Centre Supat. from the Registrar. 6. The candidates of Prabhakar and Praveen can only appear in one subject. Note : Form will not be accepted without Photo. Examination Application Form for December/May 20.... CATEGORY — General/Teacher/Improvement for Division. Roll No. 1, Name of candidate in English (Block Letters, 2, Father's Name in English (Block Letters) 3. Mother's Name in English (Block Letters) [ T 4. Permanent Address (Block Letters) 5. Present Address (Block Letters) .- Phone/Mob. No. : (i) Nationality . (i) Aadhar No... (0) Date of Birth (Day / Month / Year) (ii) Emai Educational qualification... Details of Examination in which the candidate wants to appear. @ Class (i) Subject (i) Name of Centre & Centre No. nH. 10. For eligibility to appear in the examination aforementioned, attach X~ox copies of previous examination marksheet/certificates duly attested. Details of last music examination passed- Pin... © Erno () Class. ‘ (i) Subject (ii) Year. (iv) RollNo.... (v) Resutt. (vi) Centre... 11. Amount of fee paid to the Centre Superintendent. Rs. eee WOLDS). 12, Number of enclosures attached 13. Mark-sheet and Certificate required at home address or through Centre Superintendent Signature of Candidate, ree ADMIT CARD Secretary Chamoe 9550 2106308 Prayag Sangit Samiti, Allahabad woos. 222 ree: 882 248078 bs Ena pameaa etlgmataen we (PROVISIONALLY ALLOWED) a . Photo of the Examination Year- Dec'18/May'19 Roll No, eect, | Name of the Candidate : Sri/ Smt/Km. the Exam, should be attested by the Centre Supdt. Name of Centre & Centre No. NOTE - 1. All entries to be filed in by the candidate except the Roll Number which willbe filed in by the Registrar Office. 2. Before appearing in the examination the following documents may kindly be sent otherwise the examination form will be rejected (2) The marksheet of previous Sangit examination, (©) The attested copy of High School or equivalent exam. passed certificate or marksheet Registrar Exam Mob. 09450628625(have carefully read the rules, regulations and the syllabus concerning the examination and | assure that | will abide by them in word and spirit. (ii) enclose with this form the prescribed examination fee by Bank Draft / Postal Order or have deposited the fee in cash with the Centre Superintendent. (i) agree to appear in the examination at a place other than the centre mentioned in this form which should be Registrar so decide. i (lv) lagree to the condition that subject matter of any dispute conceming Prayag Sangit Samiti and myself will be subject to jurisdiction of courts only in Allahabad. (v)_ Entries from 1 to 11 are correct to the best of my knowledge. Date. ene ee Full Signature of the Candidate DECLERATION BY FATHER/GUARDIAN (IF CANDIDATE IS MINOR) ‘hereby declare that | have carefully read the rules, regulations and syllabus concerning the examination and assure that my ward is fit and eligible to appear in the examination. | take full responsibility of following the Prescribed rules, regulations and directions/orders of the Registar concerning the examination by my ward. The Provision (iv) above regarding jurisdiction of Courts at Allahabad is acceptable to me. Date..... Signature of Father/Guardian Full Name.... DECLERATION BY CENTRE SUPERINTENDENT I hereby declare - (That the application of SriSmt./Km. oe eee ..is fitand eligible to appear in the examination and that there is nothing against him/her to disqualify him/her from appearing in the examination. ‘ (ii) That | have thoroughly checked this Examination Application Form filled in by the candidate and that the particulars given by the candidate in this form are complete, true and in accordance with the examination rules of the Prayag Sangit Samiti, Allahabad. (li) That the candidate has paid the requisite amount of examination fe€ RS. «...::eieneeeeennVide Bank Draft No. +-6dt0M, reese POStal Order No./NOS..... or cash tome. Note : The total examination fee of all the candidate must be sent alongwith the examination forms otherwise the examination result will be withheld, Date Centre No..... : Signature of Centre Superintendent Full Name. (Seal) Pin Code : Phone/Mob. No. E-mail Details of Examination Fees to be paid (in Rupees) Last date for forms to reach the Year of Examination Prayag Sangit Samiti, Allahabad Spp | on om Wov vi vi vit | Decemeber May Form Fee 30 30 30 30 90 30 30 30 30 Form ProcessingFee 20 20 20 20 20 20 20 20 20 | Exam. ea Exam Fee 310 365 990 985 405 995 550 715 725 | Stst Oct. 2018 31st March 2018 Certificate Fee 50 50 60 60 Total 960 415 490 435 505 445 660 765 835 In addition the following Administrative Expenses is Payable as under to the centre superintendent concerned : 140 140 140 150 180 170 190 No. form will be entertained after aforesaid dates, 1. Every candidate will be issued an admit card by the Registrar which he/she will get from the Centre Superintendent. The candidate will keep the Admit Card with hinvher during the course of theory and practical examination and will show it to the examiner or to any authority or representative of the Samiti on demand 2, Praveen theory examination will only be conducted at Prayag Sangit Samiti Allahabad in the month of May and there after the Practical examination will be arranged. P.S.S. 2,26,000/2018-19