Serial No. – MAHISHADAL RAJ COLLEGE (Govt. Sponsored) P.O. : MAHISHADAL :: DIST : PURBA MEDINIPUR :: WEST BENGAL APPLICATION FOR ADMISSION TO THE B.A. / B.SC. / B.COM. (HONS. & GEN.) COURSE 1ST YEAR SESSION : 20………. – 20……… Course : B.A. / B.Sc. / B.Com. Honours (Subject …………………………………) / General FOR OFFICE USE Date of admission ………….……... Form issued on ……......…... PASSPORT SIZE Class ………………………….……. PHOTO TO BE PASTED HERE Roll No. ………………………….…. Signature Signature 1. a) Name in full (in Block Letters) : …………………………………………………….…...… Sex – M F b) In Bengali Scripts : ……………………………………………………………………………………....………… c) Address : Vill. : ……………….…………… P.O. : …………..…...………… P.S. : ……….………………….. Dist. : ………………………………………....….…. Contact No. (if any) : ………...………..….…………….. d) Nationality : …………………………………. Religion : ………….………………. Minority : Yes No e) Caste : Gen. S.C. S.T. O.B.C. / Sub caste : …………………..…..…… P.H. : Yes No (Attested copy of Relevant Certificate to be attached) f) Date of Birth : DAY : MONTH : YEAR : 2. a) Father’s Name : ……………………………………………………………………………………………….…… b) Mother’s Name : ………………………………………………………………………………….……………….. c) i) Guardian’s Name ……………………………………………………………...………………………………. ii) Relationship with Guardian : ………………..…………………………… iii) ……………………………….. 3. a) Particulars of H.S. / Equivalent Examination Passed : i) Examination : ………………………… ii) Roll & No. : ……….…………….….….. iii) Year : ……..….….. iv) Name of the Council / Board : ………………………………………………………………………………... v) Name of the School : ………………………………………………………………………………………….. b) Statement of marks obtained in the Examination (Attested copy of Marksheet to be attached) : Subject Bengali English Remarks Th. Pr. Th. Pr. Th. Pr. Th. Pr. Th. Pr. Full Marks Marks Obtained 4. Subjects to be taken up : B.A./B.Sc./B.Com. Honours (in Block Letters) : ……………………………………………….………………. General : i) ……………….……….………. ii) ……………..…………………. iii) ………….…………………. [ 2 ] 5. For Migration Cases : Board / Council / University from which migrated : ………………………………………………………..…… 6. Where do you propose to reside, if admitted : …………………………….…………………………………… ………………………………………………………………………………………………………………………. Name of Local guardian : ………………………………………………………………………………………… Address : …………………………………………………………………………………………………………… …………………………………………………………….. Relationship : ………………………………………. DICLARATION BY THE CANDIDATE I do hereby declare that the above particulars are true to the best of my knowledge and belief and no relevant information are suppressed or omitted. I do hereby declare also that I shall not be allowed to fill up the form for University Examination unless I secure at least 75% class attendance as per Regulations of the Vidyasagar University. I promise to abide by the rules and regulations of the College. Date : ……………………….. …….………………………………………. Signature of Candidate DICLARATION BY THE FATHER / GUARDIAN I do hereby certify that the applicant has taken my permission to seek admission in Mahishadal Raj College, Mahishadal, Purba Medinipur and also the statements made therein are to the best of my knowledge based on fact. Date : ……………………….. …….………………………………………. Signature of Father / Guardians Admit Verified Principal / Teacher-in-Charge Signature .