DR. BHIM RAO AMBEDKAR UNIVERSITY, AGRA
Sample Examination Form for data entry purpose : 2012‐2013
College Code/Name : …………………………………………………………………………………………………………………………………..
Name Course :

Main Exam.

Re Exam.

Ex. Exam.

Personal Detail
Name of Student

:

Mother’s Name :

Father’s Name

:

Nationality

:

Date of Birth

:

Religion

:

Sex (M/F)

:

Original Resident of UP/Other :

Category (Gen/OBC/SC/ST) :
Medium of 10+2 Exam. :
(Hind/English)
Address
:
Post Office
:
District
:
Pin code
:

Sub‐Category (PH/FF) :

Mobile No.

OFFERED SUBJECTS FOR EXAMINATION
Name of Subject

:

Paper Code

DETAIS OF PREVIOUS EXAMINATION RESULTS
Course

Roll No.

Subject

Board/
University

Marks
Obt.

Max.
Marks

Year

Division

High School

Intermediate

UG Part I

UG Part II
UG Part III
UG Part IV
PG Previous
PG Final

( Signature of Candidate )