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.     

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

Name of candidate :_______________________________

2.      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 & 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