ADMISSION FORM FOR SEMESTER - 4

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: 9903958564
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 : 7890807320 -
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: 7890807320
EMAIL : DMAINAK56@GMAIL.COM ANNUALLY FAMILY INCOME : BELOW 5000
COURSE/PROGRAM : B. SC. PHYSICS HONS SUBJECTS : PHYSICS, CHEMISTRY, MATHEMATICS
SEC SUBJECT : LCC SUBJECT :
GENERIC SUBJECT CHOSEN : CHEMISTRY

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

Print this page