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-001037 20180469 BAKUL PAL
CU REG NO: 058-1111-0412-18 CU ROLL: 183058-21-0057
YOUR PERSONAL DETAILS:
FATHER'S NAME: BALARAM PAL MOTHER'S NAME: KRISHNA PAL
GUARDIAN'S NAME: BALARAM PAL GUARDIAN'S PHONE: 7063473710
DATE OF BIRTH : 31/08/1998 GENDER: M
CATEGORY: UNRESERVED RELIGION: HINDUISM
NATIONALITY: INDIAN STATE: WEST BENGAL
POLICE STATION: PATHAR PRATIMA COUNTRY: INDIA
AADHAAR NO: 783677968729 BLOOD GROUP : - PHONE : 6290998595 -
PERMANENT ADDRESS:
VILL AND PO - CHHOTO BANASHYAM NAGAR PS-
PATHAR PRATIMA
WEST BENGAL PIN: 743371
PRESENT ADDRESS:
VILL AND PO - CHHOTO BANASHYAM NAGAR PS-PATHAR PRATIMA
WEST BENGAL PIN: 743371
PIN CODE: 743371 PHONE: 6290998595
EMAIL : PALBAKUL1998@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 :

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