COUNCIL COPY / INSTITUTE COPY Sl. No.

X/RG/ 024517
WEST BENGAL STATE COUNCIL OF TECHNICAL AND VOCATIONAL EDUCATION AND SKILL DEVELOPMENT
(Under West Bengal Act XXVI of 2013)
[Vocatonal Educaton Division]
Karigori Bhavan, 5th Floor, Plot-B/7, Acton Area-III, Newtown, Rajarhat, Kolkata-700160

REGISTRATION FORM (FOR 10+2 LEVEL)

Registration Year : 2020 - 2021

Institute Code : 3400

Institute Name :

BARSUNDRA HIGH SCHOOL (H.S.)

1. Migration Details :
Type : NON-MIGRATING

Certificate No. :

2. Name of the Student in full (BLOCK LETTERS) [As recorded in the Madhyamik Certificate] :
RATAN DAS

3. Address :
Line 1 : BARSUNDRA

Line 2 :

Line 3 :

District : PURBA MEDINIPUR Pincode : 721654

4a. Personal Information :

i.Mobile No. : 6789955467 ii.Email :

iii.Citizenship : INDIAN iv.Caste : GEN

v.Religion : HINDU vi.Other Information : NONE

vii.Date of Birth : 20/02/1998 viii.Gender : MALE

ix.Marital Status : Unmarried x.Aadhaar No :

4b. Kanyashree Information :

i.Kanyashree : No

ii.Enrollment no : iii.Status :

4c. Family Information :

i.Father's Name : ABANI DAS

ii.Mother's Name : ANITA DAS

iii.Guardian Name :

iv.Relationship with the Guardian :

v.Annual Income of Family (in Rs.) : 56,000.00

vi.Whether the Candidate belongs to BPL : NO

Discipline : ET Group : ETCM

5. Subject Information : ClassXI ClassXII ClassXI ClassXII

First Language : BEN1 BEN2 Second Language : ENG1 ENG2

BVP1 + VP1 : FMTD CMNT BVP2 + VP2 : : FDWK VBIT
Academic Elective Paper I : MTH1 MTH2 Academic Elective Paper II : BSPC CHEM

Common Paper : EDCA ENST Optional Paper: PHYS

* Particulars of the Last Qualifying Examination :

Name of the Examination Authority : WEST BENGAL BOARD OF SECONDARY EDUCATION

Name of the Examination : MADHYAMIK

Year of Passing : 2014 Marksheet No. : M/140896
Marks Obtained in Madhyamik Pariksha (W.B.B.S.E) / Equivalent Examination :

First Language : 100 Marks / Grade : 45

Second Language : 100 Marks / Grade : 46

Third Subject : 100 Marks / Grade : 35

Fourth Subject : 100 Marks / Grade : 36

Fifth Subject : 100 Marks / Grade : 38

Sixth Subject : 100 Marks / Grade : 45

Seventh Subject : 100 Marks / Grade : 32

(For Migrating Student only : Original migration certificate,attested copies of admit card and mark sheet are to be attached)

* Other Details :
Date of Admission to 10+2 Level Course : 12/09/2020 Classs Roll Number : 19

Certified that (a) I am not a passed out student of H.S. course or its equivalent (b) I am not undergoing any full time course concurrently under any board / Council / University (c) The
particulars given above are correct.

Signature of the Candidate

This is to certify that the candidate whose details are presented in this Registration Form is a bonafide student of this Institution. He/She is not undergoing any course of study in this
Institution under WBCHSE / W.B. Madrasah Board or its equivalent. Therefore, he/she may be registered as a student of West Bengal State Council of Technical And Vocational
Education And Skill Development (VED) and a Registration Certificate in this regard may kindly be issued.

Date

Place
Signature of the Head of the Institution with Office Seal

Data submitted from: 103.127.61.108 Generated on: 10/11/2020 6:53:44PM