DOWNLOADED FORM
ASSAM UNIVERSITY, SILCHAR
(A Central University established in 1994)
APPLICATION FORM FOR REGISTRATION
SESSION _______________
For Office Use only
REGN. NO.___________________________
Name of the Dept/College _____________________________ Name of the Course ________________ Stream _______

1. Name of the Candidate in full (as recorded in the HSLC Certificate) in block letters only :
2. Sex : (tick in the appropriate box) :
M
F
3. Date of birth as per HSLC record
(HSLC Admit Card must be enclosed)
Date
Month
Year
4. Religion : ________________
5. Category (tick in the appropriate box) :
GEN
SC
ST
OBC
(certificate in support of SC/ST/OBC to be enclosed)
6. Father’s Name (in block letters) :
7. Mother’s Name (in block letters) :
8. Permanent Address including Pin Code and Phone No. __________________________________________________________________________________________________________________________________________________________________
9. Present Address with Pin Code and Phone No.
__________________________________________________________________________________________________________________________________________________________________
PIN NO.
PIN NO.
Phone No. (L)
Phone No. (L)
Phone No. (M)
Phone No. (M)
10.(a) Examination Passed : (copy of mark sheet of all Examination passed must be enclosed)
Total Marks
Name of the Exam. Passed
Name of the Board / University
Year of Passing
Division / Class
Marks Obtained
%
H S L C / Equivalent Examination
HSSLC / Equivalent Examination
B.A/B.Sc/B.Com/ Equivalent Exam
LLB
P.G / Equivalent Exam
B. Ed.
Others
(b) Institution where studied last : ____________________________________________________________
(c) Reasons for leaving last Institution : ____________________________________________________________
(d) Roll No. & Year of Passing last exam : ____________________________________________________________
(e) If you were registered with any other
University, please state Registration No.
with year and Name of the University : ____________________________________________________________
(Migration Certificate in original must be enclosed)
11. Date of Admission in present course : ____________________________________________________________
12. (a) Details of intervening Gap period(s) before joining the course, if any : ____________________________________________________________

(b) Reason for intervening Gap :
(Appropriate Gap Certificate from institution last attended must be enclosed)
________________________________________________________
13. Name of the employer, if employed :
(NOC from employer must be enclosed)
___________________________________________________________
14. Details of the Title of the M.Phil / Ph. D. if applicable : ___________________________________________________________
___________________________________________________________

DECLARATION
I do hereby declare that the above mentioned statements made by me are true and correct to the best of my knowledge and belief. Further, I do undertake that in case any portion of statement made by me is found to be incorrect at any stage, my Registration with this University shall liable to be cancelled. I also declare that I have neither registered myself with any other University nor I am studying in any other course of this University or other University.
Date :…………………….. Full signature of the candidate
Place:…………………….
Recommendation of the Principal / Head of the PG Deptt.
This application form for Registration is forwarded after verification of necessary documents. The relevant documents are checked and found correct. The candidate may be registered with Assam University as he/she fulfills all eligibility conditions.
Date: ……………………….. Signature of Principal of College /
Place: ……………………….. Head of PG Department
with office Seal
INSTRUCTIONS
1. Candidates are required to fill up the forms (all columns of the form in English letters only) in their own handwriting and shall submit the same to the office of the concerned Head of the Department / Principal of Colleges. No individual candidate should approach this Office (Registration Cell of AU) for the purpose of Registration, rather the candidate should contact their respective Departments / Colleges for collection of forms, submission of forms, collection of Registration Certificates, Correction / Clarification etc.
2. Registration Forms along with copy of HSLC Admit Card, Cast Certificate (if any), Pass Certificate, Mark sheet of all Examination passed, Migration Certificate (in original) (wherever required), Gap Certificate (wherever required), and fees must be submitted within two months from the date of admission OR within the date notified by the this office from time to time through the Head of PG Deptt. / Principal of Colleges.
3. Application for Registration should be forwarded to the COE in a lot duly verified and recommended by the Principal of Colleges / Head of the Department along with a stream wise statement of the students.
4. At present the Registration fee is 250/- for IPP course and 300/- for all other courses. This is however subject to change.
BIP/R/2012