THE UNIVERSITY OF BURDWAN Examination Form B.A. GENERAL 2ND Semester. Serial No. …………………(Office use) College Roll No………………

Through the Principal , Aghorekamini Prakashchandra Mahavidyalaya All columns must be filled in. If any column is not applicable, please write N.A. use only pointed black ink pen. Course in which admitted B.A. GENERAL Steam/Subject Arts

Subjects College Code 401 Category AP Date of Birth Gender Male / Female Marital Status Married / Unmarried Differently Abled Yes No Religion SC/ST/OBC(A/B)

Student Name(in Block letters as in M.P. or equivalent examination) Father’s Name

Mother’s Name

Name of Spouse

Minority Community Yes No

Address for Correspondence

Locality/Village State District

P.O. Country

City/PS Pin code

Email ID Mobile No.

Session of Admission to the College in Sem-I

Subjects:- Write the full name of the subject and title in the box CC-1B CC-2B

Subjects:- Write the full name of the subject and title in the box

Language –L2-1 BENGALI Compulsory BENGALI (AECC-2)

Registration No. with year of the University

Roll & No.

Whether transferred from one college to another college (if yeas give details)

From College to College

Forwarded I solemnly declare that if any of the statement in this The Particulars furnished above application is found to be not true, or if it appears Are correct that, in the opinion of the University, I have in any ………………………………….. way contravened the provisions of the University (Signature with office Seal of Ordinances, Regulations & Rules relating to the the Principal of the College) aforesaid examination, my admission to the examination will be liable to be cancelled by the University. Affix recent Date………………… passport size (30mmX45mm) Photograph Ph.No……………….. within this box without any signature

(Signature of the Student in full)