Student Id: KBC2100001555 KHUDIRAM BOSE CENTRAL COLLEGE 71/2A, Bidhan Sarani, Kolkata - 700 002 NAAC Accredited with 8 Grade Application Date: 03 Aug 2021 FOR OFFICE USE ONLY Roll No. _. N] st[N] osc-a[N] oxc-a[N] PH[N Checked & Verified Approved sd/- sd- For Department Sign. of the Principal / Authority Application details # 1 Form No, KBC2I01001555 subject and University of Calcutta will not issue admit card against any such case. Personal details Name in Full Date of girth Gender Religion Category Pwo Aadhar No. Minority Group Reg. under CU? Whether BPL Willing to Join Sports Stream Subject BAGEN BA. General RIMA BISWAS. 06 Mar 2002 Female Hinduism, General No 737657832916 No No No Nec No Combinations AEC! ENGG-HISG-PLSO- ENOM lcc2 | Merit BNOL | 259,00 LCC I: ENGC | AECC 2: ENS. * Subject in which an applicant failed in the previous qualifying examination cannot be taken either as honours or Elective 3. Marital Status 5. Nationality 7. Blood Group 9 Domicile mews 13, Hostel Required 15. Mother Tongue 17. Ist Gen. Learner 19. Annual Income : Unmarried Indian oF : West Bengal No Bengali : Yes : & 84,000.00Student Id: KBC2100001555 Application Date: 03 Aug 2021 % Guardian details 1. Father Name BISWANATH BISWAS 2. Qualification X and below 3. Occupation Business 4. Mobile 9836038227 5. Mother Name TULU BISWAS 6. Qualification Xl 7. Occupation Housewife 8. Mobile 9674030882 9. Guardian Name BISWANATH BISWAS 10. Relationship Father 1. Occupation Business 12. Mobile 9836038227 13. | Railway Station BIDHAN NAGAR 14. No.of Family Mem. : 4 Bi contact details Permanent Address © 1. Address BHATENDA (WEST) KALIBARI ROAD RAJARHAT 2. PO. RAJARHAT 3. PS RAJARHAT 4, Locality 2 Semi-Urban 5. City/Village : BHATENDA 6. District NORTH 24 PGS 7. state West Bengal 8. Country 2 India 9. Pin 700135, Communication Address © 1. Address : BHATENDA (WEST) KALIBARI ROAD RAJARHAT 2. PO. RAJARHAT 3. PS. RAJARHAT 4, Locality 2 Semi-Urban 5. City/Village : BHATENDA 6. District NORTH 24 PGS 7. state West Bengal 8. Country : India 9. Pin 700136 Contact info ® 1. Mobile No. 8617767954 2. Alt. Mobile No. : 9836038227 3. Whatsapp No. 8617767954 4, E-mailld —: rima63ing¢@gmail.comStudent :KBC2I00001555 AOU. A Application Date: 03 Aug 2021 © Qualifying Examination details Board Name WEST BENGAL COUNCIL OF HIGHER SECONDARY EDUCATION Result declared: Yes Passing Year: 2021 Stream parts RollNo./ UID: 463621 - 9 Registration No. : 4192359191 institution Name RAJARHAT SIKSHA NIKETAN (HS) Institution Address _:illhatenda, PO & PS:Rajarhat, KOLKATA, WEST BENGAL, INDIA - 700135 Medium of instruction: Bengali Passed (10+2) from NFESystem —: No Haye you studied "ENVS" of atleast 100 Marks Paper as an Compulsory Elective Subject? _—_: No # subject — Full Marks Poss Marks Marks Obtained reel Theory Practical Theory Practical Theory Practical 1 BENGAL yes 80 20 24 6 44-20-6400 2 ENGLISH yes 80 20 © 24 6 45 20 65.00 3 COMPUTER APPLICATION 7m 3 a 8 35-30-6500 4 EDUCATION so | 20 | 24 6 45-20-6500 5 HISTORY so | 20 | 24 6 40 20 6000 6 PHILOSOPHY so | 20 | 24 6 43-20 6300 7 ENVS / EED / ES o 0 0 0 0 oO 0.00 Aggregate (Top 4) :6475% | do hereby declare that (i) All entries made by me in this form are true. if any thing found otherwise, my candidature shall be liable to be cancelled. (i) Application will be cancelled if any mistake repugnant to the cause is detected irrespective ofits origin (i) My studentship wil be lable to be canceled Ifthe statement made in the form and/or the documents submitted are found to be false in any stage. (Iv) | undertake to abide by all the rules and regulations of the college and university now in force or to be in force during the course of my study in this college. (v) I fail to submit migration/registration certificate (it required) within the stipulated period, | would not request the authority to condone any decision with regard to continuation of studentship in this college. (vi) Failure to attend 75% of classes held or follure to secure pass marks in each subject in test examination would debar me from being sent-up for respective degree examination, ALL ADMISSIONS ARE PROVISIONAL, SUBJECT TO SCRUTINY BY THE COLLEGE AND THE UNIVERSITY. (COLLEGE AUTHORITY WILL NOT BE RESPONSIBLE IF SUCH ADMISSION IS REFUSED BY THE UNIVERSITY. Signature of the Guardian with Date For office use only ‘Semester - Semester - Il Semester - Ii 3 Semester - IV ‘Semester - V i Semester - VI Signature of the Candidate with Date