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Form No. : Y E A R APPLICATION FORM Date : D D M M Y Y Y Y

VYAVASAYI VIDYA PRATISTHAN SANCHALIT -

HARSUKHBHAI K . DHRUV CENTRE OF PL ANNING

C/o. IPSA, V.V.P. Campus, Opp. Motel The Village, Kalawad Road, Vajdi - Virda, Rajkot - 360 005
+91 281 27 83 701 - 702 hdcprajkot@gmail.com www.hdcprajkot.org

MASTERS PROGRAMME IN URBAN & REGIONAL PLANNING OFFERING M.PLAN (URP) DEGREE
Affiliated with Saurashtra University, Rajkot

Notes : 1. Application Form must be filled by the candidate himself in BLOCK LETTERS in BLUE INK only.
2. Last date for submission of Application Form is : _____________________. Affix Recent
3. Late submission or Incomplete Application Form shall not be accepted. Passport Size
4. Candidate must bring all Original Documents at the time of interview.
Photograph
Application Form Fees : Rs. 1,000/- by Cash OR by Demand Draft and
drawn in favor of Harsukhbhai K. Dhruv Centre of Planning Payable at Rajkot.
Sign across
to Validate
A. PERSONAL DETAILS OF CANDIDATE

Surname

First Name

Middle Name

Date of Birth DD / MM / YYYY Gender MALE / FEMALE Nationality

Caste Sub Caste

Category GENERAL / RESERVED Specify, If Reserved

E-mail ID Blood Group

Phone/Landline Mobile

B. FAMILY DETAILS OF CANDIDATE

Fathers Name

Date of Birth DD / MM / YYYY Annual Income

Occupation Designation

Office Address

Phone No. Mobile No.

E-mail ID

Mothers Name

Date of Birth DD / MM / YYYY Occupation

VYAVASAYI VIDYA PRATISTHAN SANCHALIT - +91 281 27 83 701 - 702

Affix Recent
HARSUKHBHAI K. DHRUV CENTRE OF PLANNING
Passport Size
STUDENT ACKNOWLEDGMENT SLIP Form No. : Y E A R
Photograph
and Name
Sign across E-mail
to Validate
Mobile No. Date D D M M Y Y Y Y
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C. COMMUNICATION DETAILS OF CANDIDATE

Village / City
Permanent
Address
District & State

Street & Area Pin Code

D. ACADEMIC DETAILS OF CANDIDATE

Name of Year of Total Marks Percentage

Specialisation (If any) Institute / University
Examination Passing Obtained Out of or CGPA

Graduation

Post-Graduation

Any Other

E. PROFESSIONAL OR ACADEMIC WORK EXPERIENCE

Sr. Duration
Organization Nature of Responsibility
No. From To

F. YOUR PREFERENCE FOR ADMISSION WITH RESPECT TO CATEGORY OF SEAT

TOTAL INTAKE : 20 (TWENTY) SEATS

No. Category No. of Seat Fee Per Year Preference

1 Open Category 15 (Fifteen) Rs. 1,00,000/- YES / NO

2 NRI / NRI Sponsored Category 05 (Five) US $ 3,500 YES / NO

NOTE :
Fees are subject to annual revision, as applicable.
Reservation, applicable as per the rules of competent authority.

Candidate needs to clearly mention his preference with respect to Category of Seat which entitles him to get admission
in respective selected category only.

Declaration : I hereby, declare that the information is true and to the best of my knowledge. I am aware that providing
any incorrect information &/or false documents can terminate my eligibility for admission.

Date :
Place : Signature of Parent / Guardian Signature of Applicant

Notes :
1. Deadline to submit duly filled Application Form (with self-attasted copy of all necessary documents) : ________ till ______
2. Date of FOCUS GROUP DISCUSSION & PERSONAL INTERVIEW :______________ Time : ____________
3. Candidate must to bring all necessary ORIGINAL Certificates & Documents at the time of Interview.

Signature of Administrative officer Signature of Applicant

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ENCLOSURE : SELF-ATTESTED COPY OF ALL NECESSARY CERTIFICATE / TESTIMONIALS

1. Degree (or Equivalent) and Transcript / Final Year Marksheet of Bachelor level study programme.
(Applicable for Graduate candidate)
2. Degree (or Equivalent) Transcript / Final Year Marksheet of Master level study programme.
(Applicable for Post-Graduate candidate)
3. Provisional Marksheet
(If candidate has clear the Final Exam of Qualifying Degree but Degree is not awarded)
4. Marksheet of Pre-Final Year
(If candidate has appear in Final Exam of Qualifying Degree but Result is not declared)
5. Certificate from Association of Indian Universities, New Delhi
(If candidate has obtained Qualifying Degree from Abroad / Foreign University)
6. Professional / Academic Work Experience Certificate/s (if applicable)
7. Photo ID Proof
(Aadhar Card / Passport / Driving Licence / Election Card)
8. Address Proof
(Aadhar Card / Passport / Driving Licence / Ration Card / Electric Bill)
9. Caste and Non creamy layer Certificate
(If candidate has applied for Reserved Category)
10. Passport of candidate, Parent / Guardian and NRI Sponsored
(If candidate has applied for NRI / NRI Sponsored Category)
11. Affidavit (stating complete responsibility of education & fee paying of candidate) and Relationship Statement
(stating relation with candidate) by NRI Sponsor by (If candidate has applied for NRI Sponsored Category)
12. Anti Ragging Undertaking given by the student* and by the Parents / Guardian*
(*Online form to be filled up on www.amanmovement.org website)
(Tick the Document enclosed with the application, as applicable)

UNDERTAKING

I understand that the Fees is subject to annual revision and I hereby abide to pay or collect, any difference as applicable,
as decided & directed by the management. I am aware that Fees once paid, is non-refundable and no claim shall be
made regarding the same in case of cancellation of admission. I abide to pay the remaining course-fees, if I leaves the
course Half-way.

Date :
Place : Signature of Parent / Guardian Signature of Student

UNDERTAKING

I know that in our Institute all the students studying peacefully and not a single ragging incident occurred in our college so
far. I have read the letter of D.T.E. and Hon. Supreme Court judgement mentioned there in for ragging and I know that
ragging is strictly prohibited in this college. Herewith I give assurance that...
1. I have read the notice of D.T.E. and the judgement of Hon. Supreme Court.
2. I also give assurance that I will not participate directly or indirectly in ragging or any type of ragging activities.
3. If I do so, any action taken by the Institute up to resignation is binding to me.

Date :
Place : Signature of Parent / Guardian Signature of Student