COTTON UNIVERSITY , ASSAM

APPLICATION FOR ADMISSION TO UNDER GRADUATE COURSES 2022-2023

APPLICATION ID - BAR2228395

DHE UNIQUE ID : U2203532273175

COURSES APPLIED FOR : BACHELOR OF ARTS (HONOURS) 2022-2023

SEMESTER : First semester

1. Applicant's Name in Full : MD NASIM ALI

2. (a) Father's Name : MD MUSTAKIN ALI (b) Mother's Name : NISHA BEGUM
3. (a) Date of Birth : 23-05-2004 (b) Nationality : INDIAN
4. (a) Category : UNRESERVED (b) Domicile : Assam
5. (a) Gender : Male (b) Applied for Hostel : NO
6. Economically Weaker Section : NO
7. Other Quota Applied For :
CULTURAL: NO SPORTS: NO
NCC: NO NSS: NO
SCOUTS AND GUIDES: NO STATE DOMICILE: NO
FOREIGN NATIONALS: NO MARTYRED PERSONNEL: NO
DA: NO
Particulars of Qualifying Exam
Name of Examination : HS Name of Institution : MONTFORT SCHOOL
GUWAHATI
Name of Board/Council/University : CBSE Roll : 16620448
Division : FIRST Year of Passing : 2022
Marks Secured in Qualifying Exam
Subject Total Marks Marks Obtained
BANK ACCOUNT DETAILS
Account Holder Name Bank Name Branch Name Account No IFSC Code

MD NASIM ALI INDIAN BANK KHANAPARA 6683053144 IDIB000K175

ADDRESS DETAILS
Address Line 1 : SIX MILE DARANDHA H NO 9
Address Line 2 :
Police Station : DISPUR Post Office : PANJABARI
District : Kamrup Metropolitan State: Assam
Pin : 781022
Contact Details
Contact No.: 9707455239 Email Id: nesnar69@gmail.com
I hereby declare that the information stated above are true to the best of my knowledge and
belief.In case of any false statement, I am liable to any action the University authority may
deem fit and proper.
Date : 28-07-2022 06:02:31 PM
 PAYMENT DETAILS
Amount(Rs.) Payment Date Order ID Bank Reference Number
300.00 28-07-2022 05:59:36 PM 102850520220728180105 CPABXOARS2
 COTTON UNIVERSITY , ASSAM
APPLICATION FOR ADMISSION TO UNDER GRADUATE COURSES 2022-2023
APPLICATION ID - BLA2228489

DHE UNIQUE ID : U2203532273175

COURSES APPLIED FOR : BA LIBERAL ARTS 2022-2023

SEMESTER : First semester

1. Applicant's Name in Full : MD NASIM ALI

2. (a) Father's Name : MD MUSTAKIN ALI (b) Mother's Name : NISHA BEGUM
3. (a) Date of Birth : 23-05-2004 (b) Nationality : INDIAN
4. (a) Category : UNRESERVED (b) Domicile : Assam
5. (a) Gender : Male (b) Applied for Hostel : NO
6. Economically Weaker Section : NO
7. Other Quota Applied For :
CULTURAL: NO SPORTS: NO
NCC: NO NSS: NO
SCOUTS AND GUIDES: NO STATE DOMICILE: NO
FOREIGN NATIONALS: NO MARTYRED PERSONNEL: NO
DA: NO
Particulars of Qualifying Exam
Name of Examination : HS Name of Institution : MONTFORT SCHOOL
GUWAHATI
Name of Board/Council/University : CBSE Roll : 16620448
Division : FIRST Year of Passing : 2022
Marks Secured in Qualifying Exam
Subject Total Marks Marks Obtained
BANK ACCOUNT DETAILS
Account Holder Name Bank Name Branch Name Account No IFSC Code

MD NASIM ALI INDIAN BANK KHANAPARA 6683053144 IDIB000K175

ADDRESS DETAILS
Address Line 1 : SIX MILE DARANDHA H NO 9
Address Line 2 :
Police Station : DISPUR Post Office : PANJABARI
District : Kamrup Metropolitan State: Assam
Pin : 781022
Contact Details
Contact No.: 9707455239 Email Id: nesnar69@gmail.com
I hereby declare that the information stated above are true to the best of my knowledge and
belief.In case of any false statement, I am liable to any action the University authority may
deem fit and proper.
Date : 28-07-2022 06:02:31 PM