Santiniketan Polytechnic

Approved by AICTE & Affiliated to WBSCT&VE&SD

NachanRoad,P.O.:-Kamalpur,Durgapur,Dist:- Burdwan,W.B.-713204
Application Form For Admission For the Session: - 2018-2019

Jexpo / Voclet Form No.:- ________________________Rank :- ___________________________ 1st 2nd

Year Year
Branch Name :- ___________________________________________________________________

Student Name:- S.Contact No:-

Date of Birth:- G.Contact No:-

Cast:- Minority:- Yes No Blood Group:-

Father’s Name:- Gender:-

Mother’s Name:- Aadhar

No:-
Address:- Vill:- P.S.:- Pin:-

P.O.:- Dist:- State:-

Certificate Details Board Year of Passing % of Marks Math. Ph.sc. Eng. Registration Roll No.
No.
10th

10+2

Signature By Admission Cell :- Date :-

Signature By Student/Guardian:- Date:-

Total Course Fee:- Semester Fee:-

Admission Time Paid :- Admission Time Due :-

Student Email Id:-

Accounts Details:-

School Name :-

Referred By:-

DECLARATION

I DO HEREBY DECLARE THAT ALL THE STATEMENTS MENTIONED ABOVE ARE TRUE TO THE
BEST OF MT KNOWLEDGE AND BELIEF.I PROMISE TO ABIDE BY THE RULES AND REGULATIONS
OF THE INSTITUTE AND WBSCT&VE&SD.IF THERE IS ANY FALSE STATEMENT, MY APPLICATION
FOE ADMISSION SHALL LIABLE TO BE REJECTED. I AM FULLY AWARE THAT RAGGING IS A
CRIMINAL OFFENCE & I WILL EXTEND CO-OPERATION TO INSTITUTE AUTHORITY TO
ELIMINATE RAGGING IN THE CAMPUS.

DATE: - …………………………….. ...……………………………………...

PLACE:- …………………………….. Signature of the Candidate