Admission Date:- / /20
BHARATI V IDYAPEETH
(Deemed to be University), Pune (India)
Established u/s 3 of the UGC Act, 1956 vide Notification No. F.9-15/95- U.3 of the Govt. of India
Accredited with ‘A+' Grade (2017) by 'NAAC’
66th Rank among Universities by NIRF-2018
SCHOOL OF DISTANCE EDUCATION
Recognized By UGC-DEB, New Delhi Student Photo
To,
THE REGISTRAR, BHARATI VIDYAPEETH
(Deemed to be University), Pune
Programme Name _______________ Year: I ; II ; III Academic Year: 20 - 20
1. Student Name (FULL) ______________________________________________________________________________________________
(As printed In the Mark-sheet of previous qualified examination)
2. Father/Husband Name _______________________________________________________________________________________________
3. Mother's Name (FULL) ________________________________________________________________________________________________
4. Birth-Date - 5. Sex – Male Female -
6. Area : Rural - Urban - 7. Nationality: - ____________________
8. Marital Status:- Married - Single - 9. Religion:- ____________________
10. Cast:- _________________ 11. Minority:- Yes No
12. Physical Handicapped:- Yes No 13. Category:- General Sc ST OBC Other
14. Communication Address:-__________________________________________________________________________________
_______________________________________________________________________________________________________
Tal.__________________ Dist.__________________ State_____________________ Pin___________________
15. Permanent Address:- ______________________________________________________________________________________
________________________________________________________________________________________________________
Tal.__________________ Dist.__________________ State_____________________ Pin___________________
8. Contact No. (Landline):- STD Code ________________ Land Line ________________________
17. Mobile No. (1) Mobile No. (2)
19. Aadhaar No. 20. E-mail Id ___________________________________________________
21. Admission Centre:- YMC, Pune ; SSC, Pune ; NLC, Pune ; IMED, Pune ; IMR, New Delhi ; IMSR, Navi Mumbai ;
Inst. of Mgt., Kolhapur ; YMIM, Karad ; IMRDA, Sangli ; AKIMSS, Solapur
22. Payment Status: by Demand Draft ; by Cash ; DD No ; DD Date ; Rs. _______________
23. Name of the Bank __________________________________________________________________________________________
26. Whether Employee of Bharati Vidyapeeth? Yes No ; Date of Joining
(If yes Address of the office)____________________________________________________________________________________
Unit Name : _____________________ Place ______________________ Designation ______________________________________
27. Are you existing Candidate of any College/School? If Yes: Name of Collage/School Studying & Address:- ____________________________
________________________________________________________________________________________________________
If No: Name of College/School last attended and Address:- ____________________________________________________________
________________________________________________________________________________________________________
28. Are you existing Candidate of any Board/University? If Yes: Name of Board/University Studying & Address:- _________________________
________________________________________________________________________________________________________
If No: Name of Board/University last attended and Address: ___________________________________________________________
________________________________________________________________________________________________________
29. Details of Previous year examination:
Details of Examination Board/University Month & Year of Class Total Marks Percentage
Passing / Appeared From To / Out of / Grade
SSC
HSC
Diploma………………………
Bachelor Degree………….
Master Degree…………….
Any Other …………………..
30. Details of Work Experience:
Sr. No. Name & Address Designation Period No. of Years
of the Organisation
From To
th th
31. Eligibility:- 1) 10 Marksheet (if required) ; 2) 12 Mark sheet OR 10+2 Mark sheet (if required) ;
3) Marksheets of 3 years Degree programme ; 4) Passing Certificate of last qualifying examination ;
5) Original Leaving Certificate (LC) OR Transfer Certificate (T.C) ; 6) Original Migration Certificate (MC) ;
7) Undertaking for Non submission of LC OR TC OR TC&MC ; 8) Original Bonafide Certificate (if applicable) ;
9) Work Experience Certificate (if applicable) ; 10) Cast Certificate if applicable) ;
11) Gap Certificate (if there is gap of more than 2 years in education) ; 12) Photo Identify Proof ;
13) Proof of Birth Date ; 14) Aadhaar Card ;
15) Gazette Certificate/Official Marriage Registration Certificate (in case change of name)
i) Old Name:- _____________________________________________________________________________________________
ii) New Name:- ____________________________________________________________________________________________
iii) Gazette Certificate No. _____________________________ iv) Date of Gazette Certificate __________________________________
Declaration of Candidate
I hereby declare that, I have read Application Booklet carefully and understood all instructions and conditions for the
programme to which I seek admission. I fulfill the minimum eligibility criteria. I have provided my necessary
information to the best of my knowledge and if found incorrect, I am aware that my admission shall be cancelled by the
University at any point of time and I shall not be entitled for any refund of fees.
Date:
Place:
Candidate's Signature
FOR OFFICE USE ONLY
The particulars furnished by the candidate have been checked and verified based on information provided,
provisional admission has been granted. I recommend the candidate for final a d m i s s i o n .
Application Received on: / /20
Checked By ____________________
Director Signature and Center Stamp
FOR SDE, BVDU OFFICE USE
Submitted documents verified, prescribed fees received, eligibility verified and confirmed. Admission
Confirmed.
Director SDE, BVDU, Pune
Important Note:
Duely signed print c o p y of application form s h o u l d be submitted to respective study centre within 7 days from f o r m filled date
a l o n g w i t h r e q u i r e d documents.
BHARATI VIDYAPEETH
(Deemed to be University), Pune (India)
Established u/s 3 of the UGC Act, 1956 vide Notification No. F.9-15/95-U.3 of the Govt. of India
Accredited with ‘A+’ Grade by ‘NAAC’ (2017)
66th Rank among Universities by NIRF-2018
Recognized By UGC-DEB, New Delhi
SCHOOL OF DISTANCE EDUCATION
Agreement by the Candidate
I agree that,
1. My admission to the programme applied is provisional and shall be so till the completion of the final eligibility.
2. I am eligible to the programme I have applied and that if found not eligible / or not fulfilling the conditions of eligibility as per the
rules mentioned in the prospectus / information booklet, the admission will be cancelled? And the fees paid to the University? Will
not be refunded in part or full.
3. I am aware of about the modes of delivery of the study material and I accept the said mode of delivery of study material.
4. The University reserves the right to make any changes in the rules or syllabus or study material or learning material or any policies
and that, such changes shall be binding and applicable to me and that I shall have no objections to such changes.
5. That any incorrect or incomplete information given by me is liable to cancellation of admission or withdrawal of the degree or
diploma awarded to me as and when the University gets such information.
6. I shall visit the University website regularly and undertake necessary steps as required for academic and administrative purposes.
7. I shall undertake the studies of the academic programme with honesty, discipline and good conduct and shall not be part of any
activity which is unbecoming of a student of the University.
8. I authorize the University to convey academic and administrative information by way of text messages to my mobile phone or
through email.
I agree
Date:
Place:
Candidate's Signature
