Date of Receipt

Date of Receipt_________________ Regn No._____________________ LEET Roll No.__________

(To be filled in by the office)

APPLICATION FORM FOR

LATERAL ENTRY ENTRANCE TEST - 2003

Last date for receipt of application 04-07-2003 5.00 PM

(To be filled by the candidate in his/her own handwriting in BLOCK LETTERS)

1. Name of candidate :_______________________________

2.

Affix photograph duly signed on front by the candidate and attested by Gazetted officer.   attested

Father's Name        :_______________________________

3. a) Whether belong to Haryana Open Gen. Category YES NO

b) Whether belong to All India Category YES NO

c) Whether belong to any Reserved Category of Haryana YES NO

if so, indicate code of category

4. Full Postal Address for Correspondence with Telephone No., if any

5. Particulars of Qualifying Diploma Exam :

6. I solemnly declare that I have application form in my own hand and the information given is correct. I understand that if this information is found to be incorrect at any stage, my candidature for theLEET-2003 and subsequent admission to the course shall stand cancelled.

Dated : (Signature of Candidate)

Place :

To be attested by the Head of Institutions last attended

Dated : (Signature & seal of Attesting Authority)

Place :

LIST OF ENCLOSURES :

1. Admit Card (Two Nos.) YES / NO

2. Self Addressed envelop B & C YES / NO

3. Self Addressed acknowledgement Card YES / NO

ADMIT CARD ROLL NO.

Affix photograph duly signed on front by the candidate and attested by Gazetted officer.

LATERAL ENTRY ENTRANCE TEST 2003

(Roll No. and centre not to be filled by candidate)

Centre : ________________________________

Name : ________________________________

(In capital Letters)

Father’s Name :_________________________________

(SIGNATURE OF THE CANDIDATE) CHAIRMAN, LEET 2003