Department of Distance Education, Punjabi University, Patiala
Online Admission-cum-Examination Form 2021-22

Personal Information:-
Name in English
Name in Punjabi 1. English to Punjabi (Google Translation)
2. English to Punjabi (
Father' Name in English
Father's Name in Punjabi
Mother's Name in English
Mother's Name in Punjabi
Fee/ Payment Details :- Payment Mode :  Click here to fill fee if not filled yet
State Bank Collect Reference No./ Transaction Id/ Journal Id
Date 2021
Amount of Fee Deposited(in figures/numbers only)
Name of the Bank & Branch
Physically Handicaped 
Cancer/ Aids/ Thalassemia 
Single Girl Child 
Rural/ Urban 
Date of birth
Nationality  If other, please specify
Mobile Number
Father's mobile Number
Telephone Number
Marital Status
E-mail Id
Permanent Address
Pin Code
Click here if Correspondance Address is same as Permanent Address
Correspondance Address
Pin Code
Nad Id (National Academic Depository, if any, Optional)
Aadhaar (optional)
Set/ create Password (Maximum 8 characters only)
Please remember your password for taking print-out of forms and future use
Do you want to take benefit of Post Matric Scholarship
Are you currently holding any Scholarship?
Exam Medium
Exam Centre
Punjabi University Patiala Registration Number (if any)
Year of Registration
Is migration taken from this University
Name of the previous course & DE Roll No, if any, without Gap Session 2019-20
Write details of Qualification on basis of which you are seeking admission into this course (or Last exam passed/ appeared)
Qualification Result Board/University PassingYear Roll No. Registration No. Marks obtained Maximum Marks Percentage
Have you ever been disqualified ?    If yes, give details (Name of Exam, Session, Year, Roll No.)
Please state, if you are studying in any other minor course in an affiliated college/Deptt of this University or any other University/Board
(study in two major courses simultaneously is not allowed)
Have you passed Punjabi in Matric Exam or 10+2 or B.A. : (if yes, send proof with hard copy of admission-cum-examination form)    If yes, give Roll No, Year, Class, Name of Board/University details
Do you want exemption from postal charges?
(If yes, an application must be enclosed) (Note:- Exemption from postal charges is admissible to University employees and their wards only)
State whether you are claiming full/half fee concession? If so, state category and also attach the revelant documents in support to your claim, as per details given in the prospectus. Full/half fee concession :
Category No :
Have you attached the documentary proof in support of your claim?
Any real unmarried brother/sister studying in this department If yes, Fill Name, Relation, Course, RollNo. and Session
Have you applied for Re-Evaluation ? (Y/N)    If yes, give details
Biometric Information:-
Size of photograph and Signature must be less than 50kb.
(Less than 50kb size allowed. Only .jpg, .jpeg, .gif, .png files allowed !)
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Signature in English
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Signature in Punjabi
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