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Personal Details
Applicant's Name : AFSHANA AKTAR
Phone No : 6003561211 Email-Id : rashidabegum917@gmail.com
DOB : 20/05/2004 Ge nde r : Female Nationality : INDIAN
Re ligion : ISLAM Cate gory : GENERAL
Blood Group : B+ M arital Status : Unmarried
Fathe r's Name : ABDUL AWAL ALI Phone : 9678541625 Occupation : BUSINESS
M othe r's Name : RASHIDA BEGUM Phone : 9678541625 Occupation : HOUSE WIFE
Guardian's Name : ABDUL AWAL ALI Phone : 9678541625
Pre se nt Addre ss : KAWAIMARI BLOCK NO. 2
Pe rmane nt Addre ss : KAWAIMARI BLOCK NO. 2, GOLIBANDHA, SARTHEBARI, 781375, BARPETA

Bank Details
Account No: 34139296612 Bank Name : STATE BANK OF INDIA Branch Name : PATHSALA IFSC Code : SBIN0002099

Extra Details
Are you an applicant for e xtra curricular quota : NO
Are you an applicant for Diffe re ntly Able d quota : NO
Are you an applicant for NCC quota : NO
Whe re do you propose to re side : HOSTEL
State of Domicile : ASSAM

Educational Details
Institution Last Atte nde d : KAWAIMARI ANCHALIK HIGH SCHOOL Board/Univ e rsity : SEBA Ye ar of passing : 2021
Last Exam Roll : B21-0021 No : 0225
Marks obtained in Last Final Examination :
Name of Subje cts Total M arks M arks Obtaine d
ASSAMESE 100 71
ENGLISH 100 68
GENERAL MATHEMATICS 100 73
GENERAL SCIENCE 100 68
SOCIAL SCIENCE 100 76
ARABIC (E) 100 73
Grand Total 600 429
Pe rce ntage 71.5
Group of subjects the applicant wishes to opt. :
1. ENGLISH 2. ASSAMESE 3. ENVIRONMENTAL STUDIES 4. EDUCATION
5. POLITICAL SCIENCE 6. ANTHROPOLOGY 7. LOGIC & PHILOSOPHY

Declaration by the candidate : I do hereby declare that information furnished above are true to the best of my knowledge and belief. If any
misrepresentation of facts is detected, I shall forfeit my claim to a seat in the college. If admitted, I shall abide by the rules and regulations of the college and
hostel and uphold its dignity.

Place:
Date: (Full Signature of the Applicant)

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