Annexure - 1 : Registration Form

Form No : 3140121

UNIVERSITY OF CALCUTTA
87/1 , College Street, Kolkata - 700073, West Bengal, lndia
Website : wvwv.caluniv.ac.in I Email : calunivregn@gmail.com
Phone No : (033) 22410071 Ext - 207 I (033) 22190077
Registration Form for Under Graduate Courses
[ B.A. / B.Sc. / B.Com. (Honours / Major / General), B.Mus. (Honours / General),
BBA(Honours). BFA & BFAD ]

1.CU Registration No. (For already Registered Candidate):

Student's Photo

2.Name of the College : Sir Gurudas Mahavidyalaya

3.Course of study : B.A. Political Science (H) Major 4 Years (08) Student's Signature
4.Date of admission : 03/08/2023
5.Session of admission : 2023 - 2024
6.Whether passed (10+2) or higher Examination from Non Formal 612874241611
education system (Approved by Distance Council of lndia or UGC): No
Aadhar No.
15.Nationality: Indian
7.Name: PRITAM DAS
16. Whether Differently Abled: No
8. Father's Name: PALASH DAS
(a). Disability Code:
9. Mother's Name: SHILA DAS
(b). Percentage: 0
10. Guardian's Name: PALASH DAS
17. Contact Mobile Number: 8100387680
11. Date of Birth: 17/12/2004
18. E-mail: pd64070@gmail.com
12. Gender: M
19. Whether belongs to BPL: NONE
13. Religion: Hinduism
20. Annual Family lncome (ln Rs): 120000
14. Caste Category: SC
21. Locality Type: Semi-Urban

22(a). Present Address : 22(b). Permanent Address :

Newtown mahisgot dhalipara Newtown mahisgot dhalipara

Pin : 700102 State : West Bengal Country : India Pin : 700102 State : West Bengal Country : India

23.Subject Details : B.A. Political Science (H) Major 4 Years

Major Minor 1 Minor 2 AEC 1 AEC 2

PLSA EDCG BNGG Compulsory English Bengali

Minor1 Minor2 Minor3 Minor4

EDCG EDCG BNGG BNGG

IDC 1 IDC 2 IDC 3 CVAC1 CVAC2

Computer Library and Environmental Studies & Will Be
History
Science information Studies Constitutional Values decided later

SEC 1 SEC 2 SEC 3

Form No: 3140121

UNIVERSITY OF CALCUTTA
87/1 , College Street, Kolkata - 700073, West Bengal, lndia
Website : wvwv.caluniv.ac.in I Email : calunivregn@gmail.com
Phone No : (033) 22410071 Ext - 207 I (033) 22190077

25. Migration Status :

(a). Non-Migrating Student (Passed from WBCHSE/ WBBME/ ISC/ CBSE/ NIOS/ Rabindra Mukta Vidyalaya) ✓
(b). Mlgrating Student (Passed from other Board / University)

26. Last Qualifying Examination : H.S

(b). Board: WBCHSE - West Bengal Council of Higher
(a). Name Of The Examination : 10+2
Secondary Education
(c). Roll Number: 464911-1366
(d). Year of Passing: 2022

27. Details of subjects and marks obtained at the (10+2) level Examination / Details of
Previous qualifying examination Board / University :
(a). Subject(s) [Top
Four Subjects
(Excluding the Geography Political Aggregate of top Four
Compulsory paper Bengali Education Subjects
Science
on Environment
Education)]

Full Marks 100 100 99 100 399

Marks Obtained 90 80 75 75 320

80.200501253133%
% of Marks 90% 80% 75.757575757576% 75%

(b). Subject(s) [Others

Subjects] English Philosophy
Full Marks 100 100
Marks Obtained 67 55
% of Marks 67% 55% % % %

I do hereby declare that the statements made above are true and correct and the documents furnished along with the form are genuine to the best of my
knowledge and belief. ln case any of the documents is subsequently detected to be fake or false, my registration with the university shall be treated as
cancelled.

14-09-2023
 Date Full Signature of the Student

I certifiy that all the statements made above are verified and found to be true.

Signature of Principal / Officer-in-Charge /

Date
Teacher-in-Charge / Vice Principal with Seal

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