FORMS

SSES BOARD OF MEDICAL AND PARAMEDICAL SCIENCE RESEARCH 

Village & P.O. Raipur, Sonipat, Haryana

ADMISSION FORM  

1. Name of the Course:

2. Applicant's Name:

3. Gender:

4. Father's Name:

5. Mother's Name:

6. Date of Birth:

7. Address: ......................................................................................

..........................................................................................................

..........................................................................................................

.............................................................. Pin Code: .........................

Phone No. ............................................. Email: ....................................................

8. Summary of Educational Qualifications:

9. Bona Fide Resident of Haryana:   Yes / No (Tick the appropriate):

10. Category: GEN. / SC / ST / OBC / PH / Ex.SM (Tick the appropriate): 

11. Nationality: .................................................................................

12. Annual Income: ..........................................................................

13. Are you employed ? Give details.: .....................................................................

14. Have you ever been expelled/rusticated/punished on account of misconduct ?

15. Are you in need of Hostel ?

16. Declaration by the Applicant and his/her Father/Guardian

                  I declare that the entries made by me in this Admission Form and the documents submitted by me with the admission form are true in all respects and if in any case any information is found to be false, this shall entail automatic cancellation of my admission besides rendering me liable to such action, as the Board may deem proper.

                  I note that my admission to the Board and my continuance on its rolls are subject to the provisions/rules of the SSES/Board that in force from time to time. I shall abide the rules of discipline and proper conduct. I am fully aware of the law regarding ragging as well as the punishment and that if found guilty on this account I am liable to be punished appropriately and the disputes if any will be subject to the jurisdiction and of the Civil Court of Sonipat, Haryana only.

                  I undertake that I shall not indulge in any act of ragging.

Dated: ................................

Place: .................................         

                                                                 Signature of the Applicant                               Signature of Father / Guardian   

Note: please tick against the documents / attested photocopies, attached with the Admission Form.           

  1.       DMCs / Certificates of last qualifying examination
  2.       Character Certificate
  3.       Certificate in support of Bona Fide Resident of Haryana
  4.       Certificate in support of Date of Birth
  5.       Relevant certificate in support of Reserved Category
  6.       No Objection Certificate (NOC) from Employer (in case of employed applicant)