You are on page 1of 2

West Bengal State University

Berunanpukuria,P.o.- Malikapur Barasat, North 24 Pgs,Pin-700126 Application form for Admission

Please insert a self-attested recent coloured passport-sized photograph

Post Graduate Programme of West Bengal State University (M.A/M.Sc/M.Com Course)

Year of Passing (Undergraduate Course) .

Percentage of Marks in Honours....

If Student from W.B.S.U.mention Reg.No. . / Name of Other University.

[Last Date of Submission: 13th July, 2013]


[I hereby apply for admission as a student of the West Bengal State University. A sum of Rs.300/-(in the form of cash or a draft in favour of West Bengal State University, Payable at Barasat or Kolkata or through the University Challan No. ., Dated .) is remitted herewith as Application Fee for the academic session 2013-14. Necessary particulars, about myself given below, are true to the best of my knowledge.] 1. 2. 3. 4. 5. 6. 7. 8. 9. Course applied for Subject applied for Category (S.C/S.T/Gen/P.C.) Name of the applicant (in block letters) Gender (M/F) Date of Birth (DD/MM/YYYY) Nationality Fathers/Mothers/Guardians Name Name & Address of local Guardian

10. 11.

Address for Communication Contact No. (with STD code) Name of the College or University of which he/she was a student prior to this admission ( )/(+91)-

12.

Name of Subject : Hons. In .


*Genl Subjects: I IV II V .. III VI

*Total marks obtained in Honours subject in Part I, II and III : .

Out of total

*Percentage of marks obtained in Honours Subject (upto 2nd place of decimal) : . *Percentage of marks obtained in General Subject (upto 2nd place of decimal) : .. Do you like to avail transport, if provide? Yes / No (tick the appropriate box)

[Do not forget to attach self-attested copies of the Graduation marksheets (I+II+III), Madhyamik (or equivalent) Marksheet along with admit card, Higher Secondary (or equivalent) Marksheet and certificate and latest validated caste /tribe & P.C. Certificates, if applicable. Photo copies of Passport &Visa will be necessary for foreign nationals.] Declaration: Statements made above are true and correct and the documents furnished along with the form are genuine to the best of my knowledge and belief. In case any of the documents is subsequently detected to be fake or false my registration with the University shall be liable to be cancelled. I also declare that I shall obey the rules related to attendance and anti-ragging programme framed by the University /W.B. Government/UGC, otherwise disciplinary action may be taken against me. Date: Place: Signature of the Applicant

Note: Candidates will have to buy University Prospectus along with Application form by paying a fee of Rs.300/(Rs.150/- in case of S.C/S.T candidates) either in the form of Bank Draft (in favour of West Bengal State University) or in cash at the University Counter even if they download the application form from the website. Those who will download the application form website will have to pay the above-mentioned fee at the time submission of application form. Other students will have to pay the requisite fee at the time of buying the application form. It is to be noted that application form will be attached to the prospectus. --------------------------------------------------------------------------------------------------------------------------------------------------------

Student Copy to be filled by the Candidate


Name (In Block letters): . Subject : . Draft No. :.. Bank No :. University Challan No: . Signature of the receiver with date