Hidayatullah National Law University
Nava Raipur– 492 002 (Chhattisgarh), India
Admission Form
(Academic Year: 2020-21)
Academic Programme (B. A. LL. B./ LL. M.): …………………………………
CLAT Roll No.: ……………………………... Candidate’s recent
passport size colour
CLAT Score: ………………………………... photograph not
older than 30 days
CLAT Rank: …………………………………
CATEGORY OF CANDIDATE:…………………
(Kindly fill all the columns in Capital Letters)
1. Name of Candidate : __________________________________________________________
(As mentioned in the 10+2 Certificate)
2. Gender (Male/Fem/Third Gender) : __________________________________________________________
3. Date of Birth : __________________________________________________________
4. Mobile No. : ___________________________________________________________
5. Email ID : ___________________________________________________________
6. Aadhar Number : ___________________________________________________________
(Recommended/Optional)
7. Father’s Name : ___________________________________________________________
Father’s Occupation:
(Salaried/Business/Self Employed) : ___________________________________________________________
Contact Nos. (Land Line/ Mobile) : ___________________________________________________________
Email ID : ___________________________________________________________
8. Mother’s Name : ___________________________________________________________
Mother’s Occupation :
(Home Maker/Salaried/Business/
Self Employed)
Contact Nos. (Land Line/ Mobile) : ___________________________________________________________
Email ID : ___________________________________________________________
9. Nationality : ___________________________________________________________
10. Religion : ___________________________________________________________
11. Caste (General/SC/ST/OBC) : ___________________________________________________________
12. State of Domicile : ___________________________________________________________
13. Blood Group : ___________________________________________________________
14. Mention Area of Residence (Rural/Urban): ___________________________________________________________
15. Correspondence Address : ___________________________________________________________
(With any landmark nearby) ___________________________________________________________
___________________________________________________________
16. Permanent Address : ___________________________________________________________
(With any landmark nearby) ___________________________________________________________
___________________________________________________________
17. Annual Income of Family : ___________________________________________________________
18. Educational Details:
Examinations Year of School/College/ Medium of Score Obtained
Passed Passing University Instruction
% of Grade
Marks Point
Secured
19. Local Guardian’s Name : _______________________________________________________
Local Guardian’s Occupation : _______________________________________________________
Address : _______________________________________________________
_______________________________________________________
Contact Nos. : _______________________________________________________
20. Mention prolong health issue (if any) : _______________________________________________________
21. Mention medicine/s if any causing allergy : _______________________________________________________
22. Details of fees paid:
Amount of Fees Paid: UTR No. for NEFT/RTGS:
Date of Payment: Remitter’s A/C No.:
A/C Holder’s Name:
Candidate’s Signature
DECLARATION
We hereby declare that the information furnished above is true and correct to the best of our knowledge and belief. In case
any information and/or document submitted is found to be incorrect or forged at any stage after admission, appropriate
action may be taken including cancellation of admission. Further, we undertake to abide by the Regulations and
Disciplinary Rules as may be prescribed by the University from time to time.
(Father’s Signature) (Mother’s Signature) (Candidate’s Signature)
Date:
Place:
