Al - Ameen Mission

Khalatpur * Udaynarayanpur * Howrah

☎ 03214-257 801
Application for Admission Test Session: 2019

Enrolment No.: 334697

Payment. Ref. No.: 90521410804866

Exam Center: Murshidabad - Bhagawangola

Student Info.
Student Name: SAYAN BISWAS Class: VI Sex: Male
D.O.B: 2010-05-20 Category: OBC-A Phone No.: 8250170521
Adhar No: 206520498686

Guardian Info.
Father Name: LATE SAJAHAN BISWAS Occu.: Auto Driver
Mother Name: SUMAIYA BEWA Occu.: Biri Maker
Father's Income/Mth.: 36000 Mother's Income/Mth.: 36000

Address Info.
Vill: BARSHATIGOLA P.O.: BHAGWANGOLA
P.S: BHAGWANGOLA Dist.: MURSHIDABAD
Pin.: 742135 State.: WEST BENGAL

i hereby declare that the details furnished in the online admission form by me above are true, correct
complete and to the best of my knowledge. the institute has full right to reject/cancel my
application/enrolment, if any type of information found incorrect or incomplete. application fee will not
be refunded under any circumstances, except when the exam or admission is cancelled by the institute.

Student Signature