MAYURBHANJ LAW COLLEGE TAKATPUR, BARIPADA, ODISHA

(Affiliated to North Orissa University)

INDEX NO. ROLL NO. SL. NO.

APPLICATION FORM FOR ADMISSION IN TO 1ST YEAR (3yrs LL.B.) COURSE

OFFICE USE ONLY FOR APPLICANT Total Marks

Obtained % Sign of D.A.

Total Mark Mark Secured %

One Stamp size

photograph signed by

the applicant on the

front (to be affixed)

1. Name of the Applicant (IN BLOCK LETTERS)

2. Sex: Male/Female 3. Religion ___________________________________

4. Married/Unmarried 5. Nationality _________________________________

6. Date of Birth (As recorded in High School Certificate) IN FIGURES ________________________________________

IN WORDS ____________________________________________________________________________________

______________________________________________________________________________________ 7. Blood Group

8. (a) Land Phone No. __________________________

(b) Mobile No. _________________________________

9. Address of the applicant for correspondence:

Name:

Vill:

P.O.:

Via:

Dist.:

Pin:

Tel. No.:

To be detached and sent as Index Card.

Full Present Postal address to be written on

this Index Card

POST CARD

To

From: PRINCIPAL Mayurbhanj Law College BARIPADA

Affix Stamp

10. Mention whether Schedule Caste/Schedule Tribe ___________________________________________________ (a certificate to this effect from the competent authority must be attached)

11. Municipal Areas/Rural Area ___________________________ 11. Home District __________________________ 12. Parental Information:

13. Full Address of Father/

Guardian/Local Guardian

PERMANENT ADDRESS OF CORRESPONDENCE

FATHER GUARDIAN

Name:

Vill :

P.O. :

Via. :

Dist.:

Pin:

Tel. No.:

INDEX CARD

(To be detached and sent as Index Card.)

i) Name of Mother Occupation Mobile Phone No.

ii) Name of Father Occupation Mobile

Phone No.

iii) Name of Guardian (if other than father)

Occupation Mobile Phone No.

The undersigned acknowledge the receipt of your application for admission into 3 yrs. LL.B. course. You have assigned Index No ________________________ You are required to quote this No. in all your correspondence regarding admission, otherwise your query cannot be replied. NOTE : The present postal address to which this Index is to be sent must

be written in the reverse by the applicant.

PRINCIPAL Mayurbhanj Law College, Baripada

14. Name of the Institution last attended. : __________________________________________________________ 15. PHYSICAL DEFICIENCIES OF DISABILITY IF ANY: Yes/No 16. Educational Bio-data:

Sl No

Examination Passed

Division/Grade

Year of Passing

Name of the Educational Institution

Mark Secured University

Subject Taken

17. University Registration No. ________________________ 18. Are you a Government Servant YES/NO _____________

(If so permission from the competent authority in original should be attached)

19. If admitted, I propose to reside with my parent/Natural/Recognised Guardian/in a College Hostel/in a Recognised Hostel or Mess.

20. Any Special claim for weightage in admission.

I declare that particulars furnished in this form are true to the best of my knowledge & belief. DATE: Signature of the Applicant Principal MAYURBHANJ LAW COLLEGE BARIPADA

Your must bring with you the following document for verification.

(to be detached and sent as Intimation

Letter)

i) Intimation Letter ii) The original marksheet of +3/equivalent examination/Degree Course in any discipline. iii) The original High School Certificate iv) The original College Leaving Certificate v) The original Conduct Certificate from the Head of the Institution last attended. vi) The original and one attested photocopy of Caste Certificate. If applicable. vii) Original Income Certificate of the parent issued by the Revenue Officer not below the rank

of Addl. Tahasildar for S.C./S.T./O.B.C. students along with an attested photocopy viii) The original certificate in support of claim, if any, for reservation/weight. ix) Three (3) copies of recent stamp size photograph (attested) x) Original Migration Certificate (if the student have passed from other than N.O. University)

PRINCIPAL Mayurbhanj Law College

BARIPADA

DECLARATION & UNDERTAKING

I Sri/Kumari/Srimati ___________________________________________________________________________submit

myself to the jurisdiction of the authorities of Mayurbhanj Law College, Baripada for the session _______________ and

declare that shall abide by the rules and regulations. The decision of the authority for admission for the session

_____________ about my merit position shall be binding and acceptable to me. I do herby declare that the particulars

stated in and attached to by me this application are true to the best of my knowledge. I have read the Prospectus and

have satisfied myself that I fulfill the admission eligibility criteria. In the event of my being found ineligible even at a later

state. I undertake to forfeit my claim for admission, and if already selected/ admitted, my selection/admission shall be

cancelled. If admitted I undertake to attend all classes regularly and I will abide the rules and regulations of the College

authorities from time to time.

Further undertake that I shall not resort to ragging or any other acts of misbehaviour to the students of the

College on or outside the college premises, during the period my studentship. In case it is found that I am involved in such

ragging activities, my name shall be struck off from the institution and I will submit myself for any Legal action deemed fit

by the authorities concerned.

Signature of Mother/Father/Guardian Signature of the Applicant

Date : -------------------- Date : -------------------

INTIMATION LETTER

[PROVISIONAL]

To

(the applicant is to write his full name here) You have been selected for admission into 1st SEMESTER (3 years’ L.L.B. Course ) of the College. You should get yourself admitted on --------------------------------- During the college hour between ------------- a.m/p.m. to -------- p.m. failing which you will forfit your seat. No extension of time will be allowed.

Principal Mayurbhanj Law College, Baripada

(to be detached and sent as

Intimation Letter)