BANGABASI COLLEGEBANGABASI COLLEGE

19, Rajkumar Chakraborty Sarani, Kolkata – 70000919, Rajkumar Chakraborty Sarani, Kolkata – 700009

APPLICATION FOR ADMISSION IN DEGREE COURSE {Tick the given bellow appropriate box}

HONOURS [ ] GENERAL [ ] B.Sc. [ ] B.A. [ ] B.Com. [ ]

For office use only

For Hons. For GeneralSub. Applied For

…………….

Sub. Applied Fora)……………

b)……………..

c)…………….

Paste your recentPhotograph here

Session…………..Year……….Date of Admission…………...

Section……………….Roll ………………No…………………..

May be admitted in ...………………………………………… ..

Verified by:……… Date:…………

1. Name (Block Letter) Sri/Smt . …………………………………………………………………………………………………………...

2. a) Sex : Male/Female …….…..…………..b) Date of Birth: ………..………………c) Nationality……………….…………………

3 a) Name of Father : ………………………...……………………………………………………………………………………………..

b) Name of Mother : ……………………………………...……………………………………………………………………………….

4 a. Father: Educational Qualification…………………..…Occupation…………….……….Monthly Income………..………………

b. Mother: Educational Qualification ………….………..Occupation…………..….………Monthly Income………………………..

5. Permanent Home Address: ……………………………………………………………………………………………………………..

: Area: Panchayat/Municipal/Corporation/Others………………………………………….Phone No. ……………………………….

6. Name and Address of Local Guardian with relationship with the Applicant: ………………………….…………………………… …………………………………………………………………………………………………………..……………………………………7. Whether belongs to SC/ST/BC/Physical Handicapped/Minority: …………………………………………………………………...

8. a) Name of the Institution from which the applicant appeared in his/her last examination:…………….………………………… b) Name of the Board to which the institute is affiliated: ……………………..……………………………………………………….

9. Name of the last Examination he/she appeared……………………………………………………………………………………….

and passed with Roll………………….No…..……………Year………..…Reg. No of Council/Board………………………………Marks Obtained

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Full Marks

Marks Obtained

10. Special Aptitude in : …………………………………………………………………………………………

11. Nearest Railway 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 classesb) Candidate failed in any subject cannot take the subject as a Combination subjectc) Candidates of Science stream seeking admission in commerce stream must pass in mathematics.

ii) Caste certificate for ST/SC iii) One Stamp/passport size photograph to be pasted in the FORM

DeclarationI declare that:a) The statement made above by me are true to the best of my knowledge and belief and detection of any

misinformation after my provisional admission will make me liable to any disciplinary action taken by the authority.

b) I have not taken admission nor will take admission to any course during my studies in this institution

c) I am not employed anywhere.

d) If I am admitted I will be a full time student of this institution.

e) My name shall be automatically stuck off, if I remain absent from my classes continuously for first 20 days at a stretch without showing a reason acceptable to the authority.

Signature in full of the StudentWith date

Declaration of Guardian:

I will bear the tuition fees and others charges of my ward if selected for. Also I will look after my ward so that he follows the discipline of the college as laid down in prospectus.

Signature in full of the GuardianWith date

BANGABASI COLLEGEBANGABASI COLLEGE19, Rajkumar Chakraborty Sarani, Kolkata – 700009, 19, Rajkumar Chakraborty Sarani, Kolkata – 700009,

Tel: 033-23605995,www.bangabasi.orgTel: 033-23605995,www.bangabasi.org

RECEIPT

Sl. No.

Received an application for admission to 1st year B.Sc/B.A./B.Com(Hons./Gen.) Class from Shri/ Smt.

…….……………………………………………….bearing Roll…….………….………No…………………………of year 200……………

College Official’s Signature with Date

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d) To be enclosed with the application form : i) One attested Photo copy of mark sheet and admit card