U.T. Administration DNH & DD : Government Polytechnic Daman Admission - 2021-22.
Application Form for First Year Admission A.Y. 2021-22
Email *
Affix a recent passport size photo of the applicant, duly self attested.
Clear selection
Name of Student *
Name of Student Father *
Student Adhar Card Number *
Priority in admission ( Refer Page No. 10, point VII in brochure) *
Are you domicile certificate holder of U.T. DNH & DD ? *
Select respective admission category *
Date of Birth (dd/mm/yyyy) as per leaving certificate *
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Place of Birth (as per leaving certificate) *
Full Address of student *
Village / Town, District, State /U.T. *
Pin Code *
Mobile Number *
Email ID
Father / Guardian Details ( Name, Occupation and Address) *
Parents Annual Income from all sources *
Relationship with Guardian *
Total Marks obtained in SSC Examination or its equivalent *
Marks out of Total Marks of SSC Examination or its equivalent (e.g.: 600, 700 or 750 etc.) *
Total obtained marks sum of three subject : Maths, Science, English *
Out of marks for three subject : Maths, Science, English (e.g.: 300 or 450) *
Marks Obtained in Mathematics *
Mathematics Marks Out of (e.g.: 100 or 150) *
Marks obtained in Science *
Science Marks Out of (e.g.: 100 or 150) *
Marks obtained in English *
English Marks Out of (e.g.: 100 or 150) *
Details of SSC Examination: Passing date *
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Details of SSC Examination: Exam Seat No.: *
Details of SSC Examination: Name of Board *
Details of SSC Examination: Name of School / Institute from which passed *
Details of SSC Examination: Number of attempt in which passed *
Have you passed SSC exam or its equivalent with technical subject? *
Have you passed SSC exam or its equivalent with technical subject? If Yes, give the name of Technical Subjects Offered: *
Have you represented U.T. DNH & DD in any Sport/ Game in any National event ? If Yes give Details
Have you rendered service in NCC/ACC/Scouts and guides activities? if so give details: *
Have You Sought admission in this diploma institute before? *
Have You Sought admission in this diploma institute before? If Yes , Give Branch Name and Registration Number
Details of examination passed after SSC exam or its equivalent
Have you applied for any other courses in other institute? If Yes, details
List of attested copies of certificate to claim reserved seats and / or additional marks
Cast Certificate of Mamlatdar of DNH and Daman/Diu in case the applicant belong to SC/ST/OBC *
Certificate of Mamlatdar of DNH and Daman/Diu in case the applicant claims admission under Economy Weaker Section (EWSs) *
Certificate from District Collector in case of representing this U.T. in any sports/games in any National Event *
Certificate of handicap and disability from medical board *
Certificate of appropriate authority as regards service in para Military Forces/ Death during the performance of Duty *
Certificate from appropriate authority as regards admission against category at Page No.13-14 point VIII.B. (01 to 06) ( as mentioned in brochure) *
List of attested copies f certificate attached to this application as per requirements : ( Please, select checkbox applicable)
(a) I undertake to join the National Cadet Corps if called upon by the Principal to do so. (b) I hereby undertake, if admitted, to confirm to the Rules and Regulations at present in force or that may thereafter be made for the Govt. Polytechnic, and that so long as I am a student of the Polytechnic, I will do nothing either inside or outside the Polytechnic that will interfere with its orderly governance and discipline. (c) I hereby declare that I have not been admitted to any Polytechnic previously.(d) I hereby declare that I have not been debarred from appearing for any examination held by any Govt. Constituent Statutory Examination Authority in India.(e) I promise not to harm any other students in any form and will not in any way be involved in any kind of ragging activities.(f) I hereby declare that the Institute (Government Polytechnic, Daman ) will not in any way be held responsible for accidents/injuries during the Institution Practical/Training in Industries/Educational Tours. *
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Signature of student and Place:
Signature of Parent/ Guardian
A copy of your responses will be emailed to the address you provided.
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