BELDA COLLEGE FORM NO  

PG200446
APPLICATION FOR THE PG ADMISSION 2020-2020 APPLIED IN PG MATHEMATICS
PRINT STUDENT ID . 
CHOICE OF APPLICATION : CATEGORY - I
Name of the Applicant :  AVIJIT SAMANTA
Date of Birth : 06/08/1999 Sex : MALE Caste : GENERAL
Econ. Status : APL Religion : HINDUISM
Father's/Guardian's Name :  BHOLANATH SAMANTA
Mother's Name :  JYOTSNA SAMANTA
Address - Vill/Town :  NACHHIPUR PO : JHANJIA
PS : DEBRA Dist : Paschim Medinipur
Pin : 7211124 Contact No :  7031162223 Candidate Signature

Whether a single Girl child : N

Aadhaar Card No :  485185561711
DETAILS OF H.S./EQUIVALENT EXAMINATION :

Year of Passing Roll No Full Marks Marks Obtained

 2017  325211  1024  500  434

DETAILS OF 3YR. REGULAR B.A./B.Sc./B.Com. (HONS) EXAMINATION :

Registration No Reg. Year Name of University

 2017-1527  2017-18  VIDYASAGAR UNIVERSITY

Name of the College Last Attended Year of Passing Roll No

 MIDNAPORE COLLEGE (AUTONOMOUS)  2020  MC/UG/S-VI/20  3229

* UG FINAL RESULT PUBLISHED

Hons. Subject Full Marks Marks Obtained % of Marks

  MATHEMATICS  1950  1305  66.92

CBCS Subject

DECLARATION BY THE APPLICANT DECLARATION BY THE PARENT/GUARDIAN

1. I do hereby declare that all information provided above is correct to my belief and 1. I declare that
knowledge. information given by my ward is correct;
2. I solemnly undertake to abide by the rules and regulations of the college & university. In the event of his/her being admitted to the college, I shall pay all his/her
3. I do hereby undertake that college dues, if any, till the completion of the course.
I will not indulge in any behavior or act that may come under the definition of 2. I do hereby undertake that
ragging; my son/daughter/ward will not indulge in any act of ragging;
will not participate in or abet or propagate ragging in any form; if he/she is found guilty of any aspect of ragging, he/she may be punished as
I will not hurt anyone physically or psychologically or cause any other harm; per the provisions of UGC Regulation and/or as per the law in force.
I hereby agree that if I am found guilty of any aspect of ragging, I may be
punished as per the provisions of the UGC Regulations and/or as per the law in  
force.

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Signature of father/mother/guardian with date
Signature of the applicant with date

FOR OFFICE USE ONLY

Provisional Admission in P.G. in CLASS ROLL

SCRUTINEER PRINCIPAL CASHIER