Samalkha Group of Institution

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Personal 1
Personal 2
Education 1
Education 2
Work
Exam
Declaration
Documents

Personal 1

Your Name *

Course Applied *

Date of birth *

Email *

Phone No.

Mobile Number *

Gender *

Nationality *

Passport No(if any)

Valid Upto

Passport Issued By

KUK Registration No (If Any)KUK- Kurukshetra University, Kurukshetra

Personal 2

Father's Name *

Mother's Name *

Mailing Address *

PIN Code

State *

Local Guardian's Name(if any)

Local Guardian's Address

Relationship with Local Guardian

Local Guardian's Email id

Local Guardian's Phone No.

Education 1

Class 10th Board Name *

Class 10th School Name *

Class 10th Year of Passing *

Class 10th Marks Obtained *

Class 10th Maximum Marks *

Class 10th Marks (in %) *

Class 12th Board/University Name *

Class 12th Institute Name *

Class 12th Year of Passing *

Class 12th Marks Obtained *

Class 12th Maximum Marks *

Class 12th PCM Marks (in %)

Class 12th Marks (in %) *

Education 2

Graduation course namee.g., BTech, Bcom, etc.

Graduation University Name

Graduation College Name

Graduation Year of PassingExpected year, if not already graduate

Graduation Marks Obtained

Graduation Maximum Marks

Graduation Marks (in %)

Other Course Name

Other Board/University Name

Other College Name

Other Year of Passing

Other Course Marks Obtained

Other Course Maximum Marks

Other Course Marks (in %)

Compartment Details(If any)

Work

Do you have any Work Experience? *

Name of current/previous organization

Designation at current/previous organization

Address of current/previous organization

Period from which onwards you work at current/previous organization

Period till which you work at current/previous organization

Your Responsibility in the organization

Name of any other organization worked at

Designation at other organization

Address of other organization

Period from which onwards you work at other organization

Period till which you work at other organization

Your Responsibility in the Compny

Exam

Test 1 Namee.g.,CAT/MAT/XAT/AIEEE/Others etc

Test 1 Score

Test 1 State Rank

Test 1 All India Rank/Percentile

Test 2 Namee.g.,CAT/MAT/XAT/AIEEE/Others etc

Test 2 Score

Test 2 State Rank

Test 2 All India Rank/Percentile

Declaration

That I clearly understand my admission is Provisional and subject to Registration by Kurukshetra University, Kurukshetra/DTE/AICTE.
I undertake to abide by all rules and regulations of this institute as well as Kurukshetra University, Kurukshetra/DTE/AICTE.
I undertake that I will not indulge myself in any act of indiscipline.
I undertake that the admission offered to me on the basis of information furnished by me. In case any information or perception are found to be incorrect/false or any fact concealed, my admission shall stand automatically cancelled and forgo every right to claim for it.
I further undertake that I will make payments in time as notified by the institute from time to time.
I further understand that my admission shall stand cancel in case I absent myself from the classes continuously for one week without any intimation.
I further solemnly declare and affirm that the information detailed by me in the application form is correct to the best of my knowledge and belief and nothing has been concealed therein.

* Yes

Documents

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