Bagbazar Howrah Durgapur Agartala

Baibav Bhavan, Gurkhabasti, VIP Road,

78, Bagbazar Street Debendra Bhaban,
54/4, Andul Road, Opposite Maya Honda Showroom,
(Beside Girish Mancha), Nachan Road, Benachity,
Howrah - 711109. Near Nehru Park, Beside Bijaya Bank,
Kolkata - 700003 Durgapur - 713213
Agartala.

Name of the Branch (admission sought for): ________________________________

1. Tick mark the COURSE desired for admission:
Jyotish Ratna Jyotish Bidyabhusan Jyotish Bidyabisharad
Past your
Jyotish Martanda Ph.D (Honorary)
photo here
2. Name of the Candidate (IN BLOCK LETTERS) Mr./Ms./Mrs.:
________________________________________________________________________

3. Name of father/husband: ___________________________________________________

4. Address for communication with address proof:

_______________________________________________________________________________________________

5. Contact No.: Mobile: _______________________________ Land line: __________________________________

Email Id: ______________________________________________________________________________________

6. Academic qualification: __________________________________________________________________________

7. Age with proof: ________________________________________________________________________________

8. Mother Tongue: ________________________________________________________________________________

9. Tick mark the language(s) you can write: Bengali Hindi English

10. Tick mark medium of instruction you prefer: Bengali Hindi English

11. Any education/ knowledge/ experience in Astrology already acquired:

______________________________________________________________________________________________

12. Extra Curricular Activities:

______________________________________________________________________________________________

I hereby undertake to abide by the rules and regulations of the institute, promise to pay due respect to the teachers
and extend all kinds of cooperation.

Date:

Place:
Signature of the Candidate