BON SECOURS COLLEGE FOR WOMEN

(Affiliated to Bharathidasan University, Tiruchirappalli)

Recognised by UGC under section 2(f) & 12(B)
Nationally Accredited with ‘A’ Grade by NAAC
VILAR BYPASS, THANJAVUR - 613 006 Paste your
Recent Color
Passport Size
APPLICATION FOR U.G. COURSES Photo

For Office Use

App.No. Admitted in Remarks Date of Admission :
Admn.No. :
Principal Roll No. :

= USE CAPITAL LETTERS ONLY.

= Incomplete applications will be summarily rejected. Please tick wherever necessary

1. NAME OF THE APPLICANT

bga®
2. COURSE APPLIED FOR
3. DATE OF BIRTH DD MM YY 5. Blood Group
4. GENDER: Female Transgender ............................

OC / FC BC / OBC MBC / DNC SC / ST

6. COMMUNITY (As in T.C) Mention your sub caste .............................................................................................................

7. AADHAR No.

ROMAN CATHOILIC (RC) CHRISTIAN HINDU MUSLIM

8. RELIGION
OTHER (Specify).......................................................................

9. NATIONALITY INDIAN NRI FOREIGNER

STATE DISTRICT MOTHER TONGUE

a) INDIAN

COUNTRY VISA NO. PASSPORT NO./ VALIDITY MOTHER TONGUE

b) NRI / FOREIGNER

10. DIFFERENTLY ABLED NO YES if yes, VISUALLY HEARING ORTHOPAEDICALLY

11. PARENT’S DETAILS NAME EDUCATION OCCUPATION ANNUAL INCOME

FATHER
(jÄÊš)
MOTHER
(jÄÊš)

12. IF EX-SERVICEMAN NO........................................ REGIMENT ..................................... RANK ..........................

13. DOMICILE RURAL / URBAN 14. ARE YOU A SINGLE CHILD? YES / NO

15. ARE YOU A FIRST GRADUATE? YES / NO

16. PERSONAL IDENDIFICATION

17. NAME OF THE SCHOOL
LAST ATTENED

MEDIUM OF INSTRUCTION ON +2 Tamil English T.C. No. ............................................................................

BOARD OF EXAMINATION HSC ISC CBSE FOREIGN

PASSED OTHER BOARD / STATE ELIGIBILITY CER. NO. .......................................

YEAR OF PASSING .................................................................... NO. OF ATTEMPTS....................... REGISTRATION NO............................

18. MARKS DETAILS SUBJECT SUBJECT SUBJECT SUBJECT SUBJECT SUBJECT TOTAL MARKS
OBTAINED
I II III IV V VI (1200)
SUBJECT ENGLISH LANGUAGE

MARKS OBTAINED

19. EXTRA - CURRICULAR ACTIVITIES NCC NSS SPORTS CULTURAL OTHERS

20. BUS FACILITY NEEDED YES NO Place of Boarding ................................................

21. PERMANENT ADDRESS: ADDRESS OF COMMUNICATION

MOBILE No. MOBILE No.

DECLARTION
I ........................................................................... understand that association with any unlawful organisation is
forbidden. If selected for admission, I promise to abide by the rules and regulations of the college. All the particu-
lars stated in this application are true to the best of my knowledge and belief.

Date: x
Signature of the Applicant

UNDERTAKING BY PARENT OF GUARDIAN

In the event of the above applicant, my son / daughter / ward ..................................................... being admitted to
the College, I undertake to pay regularly all his / her dues to the college till the completion of his / her course of
studies. I also undertake to be responsible for his / her conduct, progress in studies and attendance.

Date: x
Signature of the Parent / Guardian

For office use only

Transfer Certificate HSC Mark Statement Community Certificate
Income Certificate Color Photo
Admission Committee Office

CERTIFICATES TO BE ENCLOSED
1. Original & 2 Copies of Transfer Certificate 3. Copy of Community Certificate - 1 No(s)
2. Original & 4 Copies of Mark Statement 4. Latest Copy of Income Certificate - 1 No(s)
5. Recent Color Passport Size Photo - 8 Nos.
* Aplication Cost Rs.200 + Processing Fee Rs.50 (for online)