19, Rajkumar Chakraborty Sarani, Kolkata

BANGABASI COLLEGE

!!!!9

APPLICATION FOR ADMISSION IN DEGREE COURSE

{Tick the given bellow appropriate box}

HONOURS [ ] GENERAL
For office use only

[ ] B.Sc. [ ]
For Hons.

B.A. [ ] B.Com. [ ]
For General
Sub. Applied For

Session..Year.Date of Admission... Section.Roll No.. May be admitted in ... ..

Sub. Applied For

a . b .. c .
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Verified by:

Da e:

1. Name (Block Letter) Sri Smt . ... !. a) Se" # Male $emale .....b) Date of Birt%# ..c) Nationality. & a) Name of $at%er # ..... b) Name of Mot%er # .... ' a. $at%er# (d)cational *)alification..+cc),ation..Mont%ly -ncome.. b. Mot%er# (d)cational *)alification ...+cc),ation...Mont%ly -ncome.. .. /ermanent 0ome Address# .. Area# /anc%ayat M)nici,al 1or,oration +t%ers./%one No. . 2. Name and Address of Local 3)ardian 4it% relations%i, 4it% t%e A,,licant# . .. 5. 6%et%er belon7s to S1 S8 B1 /%ysical 0andica,,ed Minority# ... 9. a) Name of t%e -nstit)tion from 4%ic% t%e a,,licant a,,eared in %is %er last e"amination#. b) Name of t%e Board to 4%ic% t%e instit)te is affiliated# ... :. Name of t%e last ("amination %e s%e a,,eared. and ,assed 4it% Roll.No..Year..Re7. No of 1o)ncil Board

!ar"# Ob ai$ed
#thers Sub. 'a&e ( Total Total Total Total Total Theoretical !ractical Theoretical !ractical Theoretical !ractical Theoretical !ractical Theoretical !ractical Theoretical !ractical Total $ention top %our in these colu&ns Top %our sub.Total o%

Full $arks

$arks #btained

1;. S,ecial A,tit)de in # 11. Nearest Rail4ay Station from Residence# ..

N"B" a) As regards practical based subjects a candidate must obtain 30% marks in theoretical papers and 30% marks in
practical papers failing which a candidate may not be considered for taking admission in 1st year degree classes b) Candidate failed in any subject cannot take the subject as a Combination subject c) Candidates of Science stream seeking admission in commerce stream must pass in mathematics d) #o b$ $n%lo&$' (ith th$ a))li%ation *orm + i) !ne attested Photo copy of mark sheet and admit card ii) Caste certificate for S$%SC iii) !ne Stamp%passport si&e photograph to be pasted in the '!()

,$%laration
- declare t%at# a) 8%e statement made abo<e by me are tr)e to t%e best of my kno4led7e and belief and detection of any misinformation after my ,ro<isional admission 4ill make me liable to any disci,linary action taken by t%e a)t%ority. b) - %a<e not taken admission nor 4ill take admission to any co)rse d)rin7 my st)dies in t%is instit)tion c) d) e) - am not em,loyed any4%ere. -f - am admitted - 4ill be a f)ll time st)dent of t%is instit)tion. My name s%all be a)tomatically st)ck off= if - remain absent from my classes contin)o)sly for first !; days at a stretc% 4it%o)t s%o4in7 a reason acce,table to t%e a)t%ority.

Si%$a &re i$ f&'' of (e S &de$ )i ( da e )eclaration o% Guardian* + will bear the tuition %ees and others charges o% &" ward i% selected %or. Also + will look a%ter &" ward so that he %ollows the discipline o% the college as laid down in prospectus. Si%$a &re i$ f&'' of (e G&ardia$ )i ( da e

19, Rajkumar Chakraborty Sarani, Kolkata !!!!9, #$l+ !--./-0!1991,((("ban2aba&i"or2

BANGABASI COLLEGE

RECE*+,
Sl. No. (ecei*ed an application for admission to 1st year + Sc%+ A %+ Com,-ons %.en ) Class from Shri% Smt // ////////////////// bearing (oll// //// ///0o//////////of year 100/////

Coll$2$ O**i%ial3& Si2natur$ (ith ,at$