ADMISSION FORM FOR SEMESTER - 3

SESSION: 2018-2019
VIJAYGARH JYOTISH RAY COLLEGE
8/2, BEJOYGARH, JADAVPUR, KOLKATA, WEST BENGAL 700032

STUDENT ID: COLLEGE ROLL: NAME OF THE APPLICANT:

STD-001034 20180460 MAINAK DUTTA
CU REG NO: 058-1111-0406-18 CU ROLL: 183058-21-0055
YOUR PERSONAL DETAILS:
FATHER'S NAME: LATE MILAN KANTI MOTHER'S NAME: MALINA DUTTA
DUTTA
GUARDIAN'S NAME: MALINA DUTTA GUARDIAN'S PHONE: 9748585528
DATE OF BIRTH : 24/11/1999 GENDER: M
CATEGORY: UNRESERVED RELIGION: HINDUISM
NATIONALITY: INDIAN STATE: WEST BENGAL
POLICE STATION: JADAVPUR POLICE COUNTRY: INDIA
STATION
AADHAAR NO: 227207675261 BLOOD GROUP : - PHONE : 9748585528 -
PERMANENT ADDRESS: PRESENT ADDRESS:
3/25B,BIJOYGARH,JADAVPUR,KOLKATA 3/25B,BIJOYGARH,JADAVPUR,KOLKATA
WEST BENGAL , KOLKATA PIN: 700032 WEST BENGAL , KOLKATA PIN: 700032
PIN CODE: 700032 PHONE: 9748585528
EMAIL : DMAINAK56@GMAIL.COM ANNUALLY FAMILY INCOME : BELOW 5000
COURSE/PROGRAM : B. SC. PHYSICS HONS SUBJECTS : PHYSICS, CHEMISTRY, MATHEMATICS
GENERIC SUBJECT CHOSEN : MATHEMATICS
DECLARATION BY THE STUDENT:

1. ALL THE STATEMENTS AND INFORMATION PROVIDED BY ME IN THIS APPLICATION ARE TRUE TO MY KNOWLEDGE AND BELIEF. IF
OTHERWISE OR IF IT APPEARS TO THE COLLEGE AUTHORITY THAT I HAVE, IN ANY WAY, CONTRADICTED THE PROPOSITION OF THE
RULES & REGULATIONS OF THE COLLEGE AND THE AFFILIATING UNIVERSITY, MY ADMISSION IS LIABLE TO BE CANCELLED.
2. IF I FAIL TO REPORT TO THE COLLEGE WITHIN 07(SEVEN) DAYS OF THE DATE OF COMMENCEMENT OF CLASSES WITHOUT
SATISFACTORY REASON & INFORMATION, THE COLLEGE AUTHORITY WILL HAVE EVERY RIGHT TO STRIKE OFF MY NAME FROM THE
STUDENTS' ATTENDANCE REGISTER.
3. I ALSO VOW TO ATTEND A MINIMUM OF 75% OF THE TOTAL CLASSES IN EACH COURSE AS PER THE NORMS OF THE UNIVERSITY OF
CALCUTTA.

DECLARATION BY THE GUARDIAN :

I, IN SUPPORT OF THE ABOVE DECLARATION BY MY WARD, COMMIT THAT I WOULD BE PREPARED TO REMOVE HIM/HER FROM THE COLLEGE
WHENEVER THE AUTHORITY CONSIDERS IT BEFITTING AND NECESSARY IN THE INTEREST OF ACADEMIC DISCIPLINE & GENERAL WELFARE OF
THE INSTITUTION. FURTHERMORE, I ASSURE THAT MY WARD WILL ABIDE BY THE RULES & REGULATIONS FRAMED BY THE COLLEGE AND THE
AFFILIATING UNIVERSITY FROM TIME TO TIME.

SIGNATURE OF THE GUARDIAN WITH DATE
FOR OFFICE USE ONLY
SECTION
ROLL NO:
VERIFICATION BY:
SIGNATURE OF THE APPLICANT WITH DATE
STUDENT ID NO:
ADMISSION DATE :

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