ADMISSION FORM SNTCSSC 2024 Batch

SATYENDRA NATH TAGORE CIVIL SERVICES STUDY CENTRE

Government of West Bengal
FC Block, Sector III, Salt Lake Kolkata: 700106
Academic Year 2023-2024
Paste colour photo
of 4.5 cm x 3.5 cm

(Fill the Form in CAPITAL LETTERS only)

1. Name of the Applicant : _____________ ____________ _________

(First name) (Middle Name) (Last Name)

2. Date of Birth : Day _____ Month _____ Year _____

3. Sex ( one) : Female / Male / Others

4. Category ( one) : General SC ST OBC PH

5. Whether presently enrolled in : Yes No

any course at any Institute?
If yes, which course and Institute? ___________

6. Whether presently employed: : Yes No

If yes, mention designation and name and place of the

employer

7. Father’s Name :

8. Father’s Occupation :

9. Mother’s Name :

10. Mother’s Occupation :

11. Total Annual Family Income :

12. Correspondence Address :

________________________________________________

13. Permanent Address

 ________________________________________________

14. Email ID :

15. Contact No.(Mobile no.) : ________________________________________________

16. Educational Qualifications

Name of the Board / Division / % of Marks /

Examination University and Year of Class / Grade
Passed School/College attended Passing Grade obtained

17. Medium of Instruction at School Level: ______________________________________________

18. Have you appeared in UPSC Civil Services or West Bengal Civil Services Exam earlier? If yes,
give below the details in ascending chronological order
Examination Year Roll No. Result

Cleared Cleared Did not

Prelims Mains clear

UPSC CSE

UPSC CSE

WBCS

WBCS

19. Do you wish to take coaching for Optional Subject? Yes No

Your choice of Optional subject in Mains Examination: __________________________________

20. Are you appearing in the UPSC CSE 2024? Yes / No

Declaration

I, _____________________________________________________ s/o or d/o

______________________________________________________________ declare
that all information given above is true to the best of my knowledge and belief.

Date: ___/____/_____
Place: ___________

Signature of the Applicant

Checklist (to be attached and self attested)

1. Identity Proof (Aadhaar, EPIC, PAN, Passport).
2. Photocopy of address proof.
3. Photocopy of all graduation level educational qualifications with mark sheets.
4. Photocopy of SC/ST/OBC category certificate, if applicable.
5. Photocopy of proof of qualifying in Preliminary or Main Exam of Civil Services Examination
conducted by UPSC, if applicable.
6. Passport size photograph to be affixed on the Admission Form.